Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China.
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.
J Clin Neurosci. 2022 Sep;103:172-179. doi: 10.1016/j.jocn.2022.07.007. Epub 2022 Jul 27.
Elevated blood glucose is frequently detected early after aneurysmal subarachnoid hemorrhage (aSAH). We aimed to investigate whether hyperglycemia at admission is associated with mortality in patients with aSAH.
In a multicenter observational study of patients with aSAH, we defined normal glycemia, mild hyperglycemia, moderate hyperglycemia, and severe hyperglycemia as blood glucose of 4.00-6.09 mmol/L, 6.10-7.80 mmol/L, 7.81-10.00 mmol/L, and > 10.00 mmol/L, respectively. We performed propensity score matching to obtain the adjusted odds ratios (OR) with 95 % confidence intervals (CI).
Of 6771 patients with aSAH, 511(7.5 %) had died in hospital, and hyperglycemia at admission was observed in 4804 (70.9 %). Propensity scores matching analyses indicated that compared with normal glycemia, the odds of in-hospital mortality were slightly lower in patients with mild hyperglycemia (OR 0.89, 95 % CI 0.56-1.40), significantly higher in patients with moderate hyperglycemia (OR 1.90, 95 % CI 1.20-3.01), and in patients with severe hyperglycemia (OR 3.45, 95 % CI 2.15-5.53; P trend < 0.001). Long-term survival was worse among patients with hyperglycemia and was proportional to its severity. Similar dose-response associations were evident for poor functional outcomes and major disability. Hyperglycemia was associated with an increased risk of hospital-acquired infections (OR 1.46, 95 % CI 1.29-1.66) and rebleeding (OR 1.58, 95 % CI 1.06-2.35).
Among aSAH patients, hyperglycemia at admission was independently associated with increased mortality. Both moderate hyperglycemia and severe hyperglycemia were associated with an increased risk of mortality, but these associations were not seen in mild hyperglycemia (blood glucose 6.10-7.80 mmol/L).
在颅内动脉瘤性蛛网膜下腔出血（aSAH）后早期常可检测到血糖升高。我们旨在探讨 aSAH 患者入院时的高血糖是否与死亡率相关。
在一项多中心、观察性研究中，我们将正常血糖、轻度高血糖、中度高血糖和重度高血糖分别定义为血糖 4.00-6.09mmol/L、6.10-7.80mmol/L、7.81-10.00mmol/L 和＞10.00mmol/L。我们进行倾向评分匹配，以获得 95%置信区间（CI）的调整比值比（OR）。
在 6771 例 aSAH 患者中，511 例（7.5%）在院死亡，入院时发生高血糖的患者为 4804 例（70.9%）。倾向评分匹配分析表明，与正常血糖相比，轻度高血糖患者的院内死亡率略有降低（OR 0.89，95%CI 0.56-1.40），中度高血糖患者显著升高（OR 1.90，95%CI 1.20-3.01），重度高血糖患者显著升高（OR 3.45，95%CI 2.15-5.53；P 趋势＜0.001）。高血糖患者的长期生存率较差，且与血糖严重程度成正比。不良功能结局和主要残疾也存在类似的剂量-反应关系。高血糖与医院获得性感染风险增加相关（OR 1.46，95%CI 1.29-1.66）和再出血风险增加相关（OR 1.58，95%CI 1.06-2.35）。
在 aSAH 患者中，入院时的高血糖与死亡率增加独立相关。中度高血糖和重度高血糖均与死亡率增加相关，但轻度高血糖（血糖 6.10-7.80mmol/L）则无此相关性。
