Glycemic indices predict outcomes after aneurysmal subarachnoid hemorrhage: a retrospective single center comparative analysis

Abstract Although hyperglycemia is associated with worse outcomes after aneurysmal subarachnoid hemorrhage (aSAH), there is no consensus on the optimal glucose control metric, acceptable in-hospital glucose ranges, or suitable insulin regimens in this population. In this single-center retrospective...

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Autores principales:	Matthew K. McIntyre, Mohamed Halabi, Boyi Li, Andrew Long, Alexander Van Hoof, Adil Afridi, Chirag Gandhi, Meic Schmidt, Chad Cole, Justin Santarelli, Fawaz Al-Mufti, Christian A. Bowers
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/04b3a1a377e4466dac075211aa63591d
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spelling	oai:doaj.org-article:04b3a1a377e4466dac075211aa63591d2021-12-02T11:46:06ZGlycemic indices predict outcomes after aneurysmal subarachnoid hemorrhage: a retrospective single center comparative analysis10.1038/s41598-020-80513-92045-2322https://doaj.org/article/04b3a1a377e4466dac075211aa63591d2021-01-01T00:00:00Zhttps://doi.org/10.1038/s41598-020-80513-9https://doaj.org/toc/2045-2322Abstract Although hyperglycemia is associated with worse outcomes after aneurysmal subarachnoid hemorrhage (aSAH), there is no consensus on the optimal glucose control metric, acceptable in-hospital glucose ranges, or suitable insulin regimens in this population. In this single-center retrospective cohort study of aSAH patients, admission glucose, and hospital glucose mean (MHG), minimum (MinG), maximum (MaxG), and variability were compared. Primary endpoints (mortality, complications, and vasospasm) were assessed using multivariate logistic regressions. Of the 217 patients included, complications occurred in 83 (38.2%), 124 (57.1%) had vasospasm, and 41 (18.9%) died. MHG was independently associated with (p < 0.001) mortality, MaxG (p = 0.017) with complications, and lower MinG (p = 0.015) with vasospasm. Patients with MHG ≥ 140 mg/dL had 10 × increased odds of death [odds ratio (OR) = 10.3; 95% CI 4.6–21.5; p < 0.0001] while those with MinG ≤ 90 mg/dL had nearly 2× increased odds of vasospasm (OR = 1.8; 95% CI 1.01–3.21; p = 0.0422). While inpatient insulin was associated with increased complications and provided no mortality benefit, among those with MHG ≥ 140 mg/dL insulin therapy resulted in lower mortality (OR = 0.3; 95% CI 0.1–0.9; p = 0.0358), but no increased complication risk. While elevated MHG and MaxG are highly associated with poorer outcomes after aSAH, lower MinG is associated with increased vasospasm risk. Future trials should consider initiating insulin therapy based on MHG rather than other hyperglycemia measures.Matthew K. McIntyreMohamed HalabiBoyi LiAndrew LongAlexander Van HoofAdil AfridiChirag GandhiMeic SchmidtChad ColeJustin SantarelliFawaz Al-MuftiChristian A. BowersNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Matthew K. McIntyre Mohamed Halabi Boyi Li Andrew Long Alexander Van Hoof Adil Afridi Chirag Gandhi Meic Schmidt Chad Cole Justin Santarelli Fawaz Al-Mufti Christian A. Bowers Glycemic indices predict outcomes after aneurysmal subarachnoid hemorrhage: a retrospective single center comparative analysis
description	Abstract Although hyperglycemia is associated with worse outcomes after aneurysmal subarachnoid hemorrhage (aSAH), there is no consensus on the optimal glucose control metric, acceptable in-hospital glucose ranges, or suitable insulin regimens in this population. In this single-center retrospective cohort study of aSAH patients, admission glucose, and hospital glucose mean (MHG), minimum (MinG), maximum (MaxG), and variability were compared. Primary endpoints (mortality, complications, and vasospasm) were assessed using multivariate logistic regressions. Of the 217 patients included, complications occurred in 83 (38.2%), 124 (57.1%) had vasospasm, and 41 (18.9%) died. MHG was independently associated with (p < 0.001) mortality, MaxG (p = 0.017) with complications, and lower MinG (p = 0.015) with vasospasm. Patients with MHG ≥ 140 mg/dL had 10 × increased odds of death [odds ratio (OR) = 10.3; 95% CI 4.6–21.5; p < 0.0001] while those with MinG ≤ 90 mg/dL had nearly 2× increased odds of vasospasm (OR = 1.8; 95% CI 1.01–3.21; p = 0.0422). While inpatient insulin was associated with increased complications and provided no mortality benefit, among those with MHG ≥ 140 mg/dL insulin therapy resulted in lower mortality (OR = 0.3; 95% CI 0.1–0.9; p = 0.0358), but no increased complication risk. While elevated MHG and MaxG are highly associated with poorer outcomes after aSAH, lower MinG is associated with increased vasospasm risk. Future trials should consider initiating insulin therapy based on MHG rather than other hyperglycemia measures.
format	article
author	Matthew K. McIntyre Mohamed Halabi Boyi Li Andrew Long Alexander Van Hoof Adil Afridi Chirag Gandhi Meic Schmidt Chad Cole Justin Santarelli Fawaz Al-Mufti Christian A. Bowers
author_facet	Matthew K. McIntyre Mohamed Halabi Boyi Li Andrew Long Alexander Van Hoof Adil Afridi Chirag Gandhi Meic Schmidt Chad Cole Justin Santarelli Fawaz Al-Mufti Christian A. Bowers
author_sort	Matthew K. McIntyre
title	Glycemic indices predict outcomes after aneurysmal subarachnoid hemorrhage: a retrospective single center comparative analysis
title_short	Glycemic indices predict outcomes after aneurysmal subarachnoid hemorrhage: a retrospective single center comparative analysis
title_full	Glycemic indices predict outcomes after aneurysmal subarachnoid hemorrhage: a retrospective single center comparative analysis
title_fullStr	Glycemic indices predict outcomes after aneurysmal subarachnoid hemorrhage: a retrospective single center comparative analysis
title_full_unstemmed	Glycemic indices predict outcomes after aneurysmal subarachnoid hemorrhage: a retrospective single center comparative analysis
title_sort	glycemic indices predict outcomes after aneurysmal subarachnoid hemorrhage: a retrospective single center comparative analysis
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/04b3a1a377e4466dac075211aa63591d
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Glycemic indices predict outcomes after aneurysmal subarachnoid hemorrhage: a retrospective single center comparative analysis

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