Artikel
The influence of blood glucose level on cerebral perfusion after aneurysmal subarachnoid hemorrhage
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Autoren
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Kerim Beseoglu
- Heinrich-Heine-Universität Düsseldorf, Medizinische Fakultät, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Ursala Tokhi
- Heinrich-Heine-Universität Düsseldorf, Medizinische Fakultät, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Daniel Hänggi
- Heinrich-Heine-Universität Düsseldorf, Medizinische Fakultät, Klinik für Neurochirurgie, Düsseldorf, Deutschland
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: Delayed cerebral ischemia (DCI) is a severe complication and significant contributor to poor neurological outcome following aneurysmal subarachnoid hemorrhage (aSAH). However, underlying causes and risk factors are still incompletely understood and subject of current research. An influence of blood glucose dysregulation on the occurrence of DCI is assumed. This study aims to analyze the influence of systemic blood glucose level on cerebral perfusion measured by dynamic perfusion computed tomography (PCT) in patients with aSAH.
Method: Daily serial blood glucose levels and PCT data sets of 220 patients treated at our neurointensive care unit after aSAH were retrospectively analyzed. PCT was performed at 24 hours after aneurysm occlusion, at day 2 to 4 after SAH and between day 9 to 11. We focused on the mean transit time (MTT) and cerebral blood flow (CBF) as the most relevant perfusion parameters in the presence of impaired cerebral perfusion from DCI. The maximum MTT (maxMTT) and minimum CBF (minCBF) parameters were correlated with defined blood glucose ranges according to recent publications as followed: 1.) >180mg/dl (Hyperglycemia) 2.) 140-180mg/dl (elevated glucose level) 3.) 110-140mg/dl (strict glucose control) and <110mg/dl (low glucose level).
Results: Elevated blood glucose levels (140-180mg/dl) showed a negative correlation with the minCBF (p=0.01 r=-0.173) whereas low blood glucose (<110mg/dl) correlated significantly positive with minCBF (p<0.01 r=0.178). Hyperglycemia (>180mg) and elevated glucose levels (140-180mg/dl) were associated with prolonged maxMTT (median 4.13s and 4.24s ) in contrast to low glucose levels (<110mg/dl) (median 3.75s p=0.019, p<0.01). In addition, a strict control of blood glucose (110-140mg/dl) was shown to correlate significantly with lower maxMTT (p< 0.01 r=-0.180).
Conclusions: The present analysis supports the assumption that dysregulation of blood glucose balance influences cerebral perfusion and thus may contribute to the occurrence of DCI. Therefore careful monitoring and prompt treatment of blood glucose levels after aSAH should be highly valued and prospective research is warranted to further define optimum values for blood glucose levels.
