Abstract TP397: Modified Graeb Score Predicts Stress-Induced Hyperglycemia After Subarachnoid Hemorrhage

Abstract

Introduction: Post-hemorrhagic hydrocephalus is a frequent complication after aneurysmal subarachnoid hemorrhage (aSAH) that can result in homeostatic derangement including stress induced hyperglycemia (SIH). Modified Graeb score (MGS) is a semi-quantitative scoring system that can estimate extent of hydrocephalus and amount of intraventricular blood. Hypothesis: We assessed whether MGS can predict SIH after aSAH. Methods: On the basis of our previous research with this same cohort, SIH was defined as a ratio of admission serum glucose (AG) to glycated hemoglobin, HbA1c (AG:HbA1c) of 26 or higher. This retrospective study reviewed charts of aSAH patients admitted to a tertiary care hospital. MGS was calculated retrospectively using admission computed tomography (CT) scans. Exploratory loess regression was used to characterize the association between MGS and SIH. Non-parametric tests were used to investigate difference in MGS between those with and without SIH. Fisher’s exact tests assessed differences in prevalence of SIH between patient groups. Results: Average age of cohort was 52.3±13.1 years with 65% women. SIH was observed in 72/165 (43.6%) patients. One hundred and eight of the 165 patients (65.5%) were modified Fisher grade 3-4 on admission CT scans. Fifty-five patients (50.9%) with modified Fisher grade 3-4 developed SIH as compared to 17 (29.8%) of patients with modified Fisher grade 1-2 (p=0.013). Locally weighted or LOESS regression showed a positive relationship between the AG:HbA1c ratio at MGS up to about 12. MGS threshold of ≥10 predicted SIH with 88.2% specificity. Although median MGS was higher in patients developing SIH (4; interquartile range or IQR 5.5) as compared to those without SIH (2; IQR 6.0), the difference did not reach statistical significance (p=0.079). Conclusion: Higher MGS, indicative of more severe obstructive hydrocephalus, is associated with increased incidence of SIH. This alludes to contribution of hydrocephalus in neurohumoral derangement and associated dysglycemia after aSAH.