Ray Bappaditya, Ludwig Ayumi, Yearout Lori K, Thompson David M, Bohnstedt Bradley N
Department of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Department of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
World Neurosurg. 2017 Apr;100:208-215. doi: 10.1016/j.wneu.2017.01.008. Epub 2017 Jan 13.
Stress-induced hyperglycemia (SIH) after acute cerebrovascular disease is common and is associated with adverse clinical outcomes. The incidence of SIH after spontaneous subarachnoid hemorrhage (SAH) and its role in shunt placement have not been systematically investigated. The present study is designed to investigate the incidence of SIH after spontaneous SAH and its determinants. The role of SIH and premorbid hyperglycemia (using glycated hemoglobin [HbA]) in predicting external ventricular drainage (EVD) and ventriculoperitoneal shunt (VPS) placement is also investigated.
This study defined SIH using the glycemic gap (GG) and admission glucose:HbA ratio. The receiver operating characteristic curve determined threshold values for GG and the ratio that best predicted incidence of adverse clinical outcomes, including in-hospital mortality.
We defined SIH using thresholds of 26.7 mg/dL for GG and 26 mg/dL for admission glucose:HbA ratio. The incidence of SIH was higher in patients with aneurysmal SAH (aSAH) (99/200 [49.5%]) than in those with nonaneurysmal SAH (16/50 [32.0%]; P = 0.03). Among 200 patients with aSAH, diabetics had higher mortality than nondiabetics (10/24 [41.7%] vs. 39/137 [21.2%]; P = 0.045). SIH among nonhydrocephalic aSAH was more likely to have EVD placed than those without (42/64 [65.6%] vs. 38/79 [48.1%]; P = 0.043). Among 143 patients with aSAH without hydrocephalus, EVD was placed more often in those with HbA level ≥6.4% (15/19 [78.9%] vs. 65/124 [52.4%]; P = 0.045). Neither SIH nor HbA level could predict VPS placement among aSAH survivors.
SIH is common after aSAH. In nonhydrocephalic aSAH, both SIH and premorbid uncontrolled hyperglycemia determine EVD but not VPS placement.
急性脑血管疾病后应激性高血糖（SIH）很常见，且与不良临床结局相关。自发性蛛网膜下腔出血（SAH）后SIH的发生率及其在分流置管中的作用尚未得到系统研究。本研究旨在调查自发性SAH后SIH的发生率及其决定因素。还研究了SIH和病前高血糖（使用糖化血红蛋白[HbA]）在预测脑室外引流（EVD）和脑室腹腔分流（VPS）置管中的作用。
本研究使用血糖差值（GG）和入院血糖：HbA比值来定义SIH。通过受试者工作特征曲线确定GG和该比值的阈值，这些阈值能最佳预测不良临床结局的发生率，包括院内死亡率。
我们将GG阈值设定为26.7mg/dL，入院血糖：HbA比值阈值设定为26mg/dL来定义SIH。动脉瘤性SAH（aSAH）患者中SIH的发生率（99/200[49.5%]）高于非动脉瘤性SAH患者（16/50[32.0%]；P = 0.03）。在200例aSAH患者中，糖尿病患者的死亡率高于非糖尿病患者（10/24[41.7%]对39/137[21.2%]；P = 0.045）。非脑积水性aSAH患者中发生SIH的患者比未发生SIH的患者更有可能进行EVD置管（42/64[65.6%]对38/79[48.1%]；P = 0.043）。在143例非脑积水性aSAH患者中，HbA水平≥6.4%的患者更常进行EVD置管（15/19[78.9%]对65/124[52.4%]；P = 0.045）。SIH和HbA水平均不能预测aSAH幸存者的VPS置管情况。
aSAH后SIH很常见。在非脑积水性aSAH中，SIH和病前未控制的高血糖均决定EVD置管，但不决定VPS置管。
