Zhang Zeyu, Zhao Yue, Liu Yibo, Wang Xiaoyu, Xu Houshi, Fang Yuanjian, Zhang Anke, Lenahan Cameron, Luo Yujie, Chen Sheng
Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Stomatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Health, Hangzhou, China.
CNS Neurosci Ther. 2022 Jun;28(6):942-952. doi: 10.1111/cns.13826. Epub 2022 Mar 15.
Despite having an overall benign course, non-traumatic non-aneurysmal subarachnoid hemorrhage (naSAH) is still accompanied by a risk of clinical complications and poor outcomes. Risk factors and mechanisms of complications and poor outcomes after naSAH remain unknown. Our aim was to explore the effect of stress-induced hyperglycemia (SIH) on complication rates and functional outcomes in naSAH patients.
We retrospectively reviewed patients with naSAH admitted to our institution between 2013 and 2018. SIH was identified according to previous criterion. Symptomatic vasospasm, delayed cerebral infarction, and hydrocephalus were identified as main complications. Outcomes were reviewed using a modified Rankin Scale (mRS) at discharge, 3 months, and 12 months. A statistical analysis was conducted to reveal the associations of SIH with complications and outcomes.
A total of 244 naSAH patients were included in the cohort with 74 (30.3%) SIH. After adjusting for age, gender, hypertension, Hunt and Hess (HH) grade, modified Fisher Scale (mFS), intraventricular hemorrhage (IVH), and subarachnoid blood distribution, SIH was significantly associated with symptomatic vasospasm (p < 0.001, 12.176 [4.904-30.231]), delayed cerebral infarction (p < 0.001, 12.434 [3.850-40.161]), hydrocephalus (p = 0.008, 5.771 [1.570-21.222]), and poor outcome at 12 months (p = 0.006, 5.506 [1.632-18.581]), whereas the correlation between SIH and poor outcome at discharge (p = 0.064, 2.409 [0.951-6.100]) or 3 months (p = 0.110, 2.029 [0.852-4.833]) was not significant. Incorporation of SIH increased the area under curve (AUC) of ROC in the combined model for predicting symptomatic vasospasm (p = 0.002), delayed cerebral infarction (p = 0.024), hydrocephalus (p = 0.037), and 12-month poor outcome (p = 0.087).
SIH is a significant and independent risk factor for symptomatic vasospasm, delayed cerebral infarction, hydrocephalus, and long-term poor outcome in naSAH patients. Identifying SIH early after naSAH is important for decision-making and treatment planning.
尽管非创伤性非动脉瘤性蛛网膜下腔出血（naSAH）总体病程良性，但仍伴有临床并发症风险及不良预后。naSAH后并发症及不良预后的危险因素和机制尚不清楚。我们的目的是探讨应激性高血糖（SIH）对naSAH患者并发症发生率和功能预后的影响。
我们回顾性分析了2013年至2018年期间入住我院的naSAH患者。根据先前标准确定SIH。将症状性血管痉挛、迟发性脑梗死和脑积水确定为主要并发症。在出院时、3个月和12个月时使用改良Rankin量表（mRS）评估预后。进行统计分析以揭示SIH与并发症及预后之间的关联。
该队列共纳入244例naSAH患者，其中74例（30.3%）存在SIH。在调整年龄、性别、高血压、Hunt和Hess（HH）分级、改良Fisher量表（mFS）、脑室内出血（IVH）和蛛网膜下腔血液分布后，SIH与症状性血管痉挛（p < 0.001，12.176 [4.904 - 30.231]）、迟发性脑梗死（p < 0.001，12.434 [3.850 - 40.161]）、脑积水（p = 0.008，5.771 [1.570 - 21.222]）及12个月时的不良预后（p = 0.006，5.506 [1.632 - 18.581]）显著相关，而SIH与出院时（p = 0.064，2.409 [0.951 - 6.100]）或3个月时（p = 0.110，2.029 [0.852 - 4.833]）的不良预后之间的相关性不显著。在预测症状性血管痉挛、迟发性脑梗死、脑积水和12个月不良预后的联合模型中，纳入SIH增加了ROC曲线下面积（AUC）（p = 0.002、p = 0.024、p = 0.037、p = 0.087）。
SIH是naSAH患者症状性血管痉挛、迟发性脑梗死、脑积水及长期不良预后的重要独立危险因素。naSAH后早期识别SIH对决策和治疗规划很重要。
