gms | German Medical Science

Objective: Aneurysmal subarachnoid hemorrhage (aSAH) can cause dysregulation of the blood glucose balance which is known to influence the clinical course and outcome. In the analysis, monitoring of serial blood glucose levels after aSAH was obtained and correlated with the occurrence of delayed cerebral ischemia (DCI) and clinical outcome.

Method: Daily serial blood glucose levels of 256 consecutive patients admitted to our neurointensive care unit after aSAH were retrospectively analyzed. We defined three blood glucose ranges based on current management recommendations for critical ill patients as followed; 1) 110-140mg/dl 2) 80-180mg/dl 3) 110-180mg/dl. Multivariate analysis was performed to correlate the different glucose management concepts with incidence of DCI and outcome measured by Glasgow outcome Scale (GOS) at discharge.

Results: Strict control of blood glucose within 110-140mg/dl was shown to correlate significantly with good clinical outcome (p<0.001). Blood glucose levels lower than 110mg/dl were associated with good outcome (p=0.018) whereas hyperglycemia (>180mg/dl) showed a correlation with poor outcome (p<0.001). Occurrence of DCI was significantly higher in patients with elevated blood glucose levels over 180mg/dl. In contrast, the incidence of DCI was lower in patients with blood glucose levels below 110mg/dl (p<0.001).

Conclusions: The present large analysis demonstrated that high blood glucose levels in patients suffering from aSAH were associated with an increase of DCI and poor outcome. Therefore, blood glucose levels should be monitored carefully and treated promptly.