14-Day Continuous Glucose Level and Mortality in Aneurysm SAH: A Retrospective Study in Neurocritical Care Unit

Abstract

Background: Aneurysm subarachnoid hemorrhage (aSAH) is a life-threatened disease. Stress responded hyperglycemia following aSAH was one of most important predictors that was associated with poor outcomes and higher mortality of patients critically suffered from aSAH. Thus, optimal glucose management strategy could improve outcomes of aSAH patients in Neurocritical Care Unit (NCU). However, it’s still lacks of evidence on glucose level which is beneficial for severe aSAH patients. Recently, glucose variability (GV) was not only used to predict clinical outcomes and mortality, but also used as a more appropriated clinical target than blood glucose range only to manage glucose level. Our study aimed to find a relatively suitable glucose control for aSAH patients in NCU. Method: 332 patients were recruited from a retrospectively collected database of all patients with aneurysm SAH (aSAH) who were admitted to Tiantan Hospital in Beijing, China between January 2015 and December 2017. We collected continuous 14-day blood glucose and calculated glucose variability. Continuous 14-day blood glucose level were divided into four groups: stable, unstable, well-controlled, bad-controlled. Other predictor variables also included admission Hunt and Hess grade, age, gender, cardiovascular risk factors, and surgical treatment. In-patient mortality was the main outcome measure. Results: Univariate survival analysis showed that the stable and well-controlled groups have higher percentage of cumulative survival than the rest two groups. Then, Multivariate COX regression analysis showed that Hunt Hess scale (HR 2.666, 95% CI, 1.438-4.944), receiving Surgery (HR 0.073, 95% CI, 0.025-0.219), having hydrocephalus (HR 3.844, 95% CI, 1.038-14.228), bleeding in cisterna ambiens (HR 8.288, 95% CI, 2.270-30.259),bad-controlled glucose (HR 5.788, 95% CI, 1.441-23.237) and unstable glucose (HR 15.403, 95% CI, 2.666-88.987). Conclusions: GV is helpful to predict aSAH mortality, either long-term or short-term. Glucose fluctuated between 7 and 10 mmol/L is associated with better 14-day clinical outcomes for critically ill aSAH patients in NCU. Funding Statement: None. Declaration of Interests: The authors declare that they have no conflict of interest. Ethics Approval Statement: This retrospective study was approved by the Ethics Committee at the Tiantan Hospital in Beijing, in accordance with the Declaration of Helsinki; patient informed consent was not required because of the anonymous nature of the data.