Glucose levels and outcome after subarachnoid hemorrhage

Mees, Sanne M. Dorhout; Dijk, Gert W van; Algra, Ale; Kempink, Dagmar R J; Rinkel, Gabriël J. E.

doi:10.1212/01.wnl.0000090466.68866.02

Cited by 79 publications

(27 citation statements)

References 11 publications

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“…rebleeding, DCI, hydrocephalus), (2) treatment-associated factors [surgical (clipping) or endovascular (coiling) complications] and (3) complications associated with prolonged bed rest [14,22,23,24,30]. Aneurysm rupture itself can cause stress hyperglycaemia, cardiopulmonary complications and increased blood coagulability, which, independent of severity of bleeding or of metabolic syndrome, may elevate the risk of poor outcome [25,30,31,32]. Outcome after SAH is thus probably determined by multiple independent factors.…”

Section: Aneurysmal Sah – Ruptured Aneurysm (Ria)mentioning

confidence: 99%

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European Stroke Organization Guidelines for the Management of Intracranial Aneurysms and Subarachnoid Haemorrhage

et al. 2013

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Background: Intracranial aneurysm with and without subarachnoid haemorrhage (SAH) is a relevant health problem: The overall incidence is about 9 per 100,000 with a wide range, in some countries up to 20 per 100,000. Mortality rate with conservative treatment within the first months is 50–60%. About one third of patients left with an untreated aneurysm will die from recurrent bleeding within 6 months after recovering from the first bleeding. The prognosis is further influenced by vasospasm, hydrocephalus, delayed ischaemic deficit and other complications. The aim of these guidelines is to provide comprehensive recommendations on the management of SAH with and without aneurysm as well as on unruptured intracranial aneurysm. Methods: We performed an extensive literature search from 1960 to 2011 using Medline and Embase. Members of the writing group met in person and by teleconferences to discuss recommendations. Search results were graded according to the criteria of the European Federation of Neurological Societies. Members of the Guidelines Committee of the European Stroke Organization reviewed the guidelines. Results: These guidelines provide evidence-based information on epidemiology, risk factors and prognosis of SAH and recommendations on diagnostic and therapeutic methods of both ruptured and unruptured intracranial aneurysms. Several risk factors of aneurysm growth and rupture have been identified. We provide recommendations on diagnostic work up, monitoring and general management (blood pressure, blood glucose, temperature, thromboprophylaxis, antiepileptic treatment, use of steroids). Specific therapeutic interventions consider timing of procedures, clipping and coiling. Complications such as hydrocephalus, vasospasm and delayed ischaemic deficit were covered. We also thought to add recommendations on SAH without aneurysm and on unruptured aneurysms. Conclusion: Ruptured intracranial aneurysm with a high rate of subsequent complications is a serious disease needing prompt treatment in centres having high quality of experience of treatment for these patients. These guidelines provide practical, evidence-based advice for the management of patients with intracranial aneurysm with or without rupture. Applying these measures can improve the prognosis of SAH.

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Section: Aneurysmal Sah – Ruptured Aneurysm (Ria)mentioning

confidence: 99%

“…Hyperglycaemia is associated with poor clinical condition on admission, and is independently associated with poor outcome [25,30,31,69]. Whether correction of hyperglycaemia results in improved outcome remains unclear.…”

Section: Aneurysmal Sah – Ruptured Aneurysm (Ria)mentioning

confidence: 99%

European Stroke Organization Guidelines for the Management of Intracranial Aneurysms and Subarachnoid Haemorrhage

et al. 2013

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“…We excluded more clinical severe patients that were admitted to the ICU, since these patients are routinely subjected to insulin in modern ICU care. However, we expect that in a population with clinically more severe aneurysmal SAH, the findings could be even more robust as abnormalities of glucose metabolism are more pronounced with more severe aneurysmal SAH [2,52]. …”

Section: Discussionmentioning

confidence: 99%

“…Hyperglycaemia occurs frequently after aneurysmal subarachnoid haemorrhage (SAH) and is an independent risk factor for increased morbidity and mortality [1,2,3]. Lowering of blood glucose levels appears beneficial for various groups of critically ill patients [4,5,6,7,8], and as such presents as a potential treatment for aneurysmal SAH patients.…”

Section: Introductionmentioning

confidence: 99%

Beta-Cell Dysfunction and Insulin Resistance after Subarachnoid Haemorrhage

Kruyt

Musters²,

Biessels

et al. 2011

Neuroendocrinology

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Background: Hyperglycaemia is a common finding and an independent risk factor for increased morbidity and mortality in aneurysmal subarachnoid haemorrhage (SAH). Although in these patients hyperglycaemia is commonly ascribed to insulin resistance, there is little understanding of underlying mechanisms. Aims: To prospectively study temporal disturbances of glucose metabolism after aneurysmal SAH in patients without known abnormalities of glucose metabolism and to explore possible correlations with markers of stress. Methods: In consecutive aneurysmal SAH patients not subjected to insulin therapy, in-hospital and follow-up oral glucose tolerance tests (OGTTs) and assessments of insulin resistance, pancreatic β-cell function, free fatty acids (FFA) and cortisol were performed and compared with reference values. Results: We included 13 patients. In the first 2 weeks of admission, median fasting glucose and FFA levels were elevated while insulin levels were not. OGTTs were indicative of glucose intolerance in all patients at days 3 and 7, while on follow-up 1 patient had glucose intolerance and all patients had normal fasting glucose levels. Pancreatic β-cell function was impaired throughout the first week and insulin resistance from day 4 to 10. Levels of cortisol correlated with higher fasting glucose and increased FFA. FFA in turn correlated with pancreatic β-cell dysfunction. Conclusions: Aneurysmal SAH patients have transient abnormalities of glucose metabolism. During the first week, it appears to result predominantly from transient pancreatic β-cell dysfunction, in combination with insulin resistance.

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“…Hyperglycaemia develops in one-third of patients during their clinical course, is associated with a poor clinical condition on admission28 and is independently associated with a poor outcome 29. Whether correction of hyperglycaemia results in improved outcome is an unresolved issue 30…”

Section: Medical Complicationsmentioning

confidence: 99%

Prevention and treatment of medical and neurological complications in patients with aneurysmal subarachnoid haemorrhage

Rinkel

Klijn

2009

Pract Neurol

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Treatment of patients with aneurysmal subarachnoid haemorrhage not only involves securing the aneurysm by endovascular coiling or surgical clipping but also prevention and treatment of the medical and neurological complications of the bleed. These acutely ill patients should be looked after in specialised centres by a multidisciplinary team that is available 24 h a day, 7 days a week. No medical intervention is known to improve outcome by reducing the risk of rebleeding but oral nimodipine should be standard care to prevent delayed cerebral ischaemia. For patients who develop delayed ischaemia, there is no evidence that hypervolaemia, haemodilution, hypertension, balloon angioplasty or intra-arterial vasodilating agents improve outcome. Lumbar puncture is a safe and reasonably effective way of treating those forms of acute hydrocephalus that are not caused by intraventricular obstruction.

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Glucose levels and outcome after subarachnoid hemorrhage

Cited by 79 publications

References 11 publications

European Stroke Organization Guidelines for the Management of Intracranial Aneurysms and Subarachnoid Haemorrhage

European Stroke Organization Guidelines for the Management of Intracranial Aneurysms and Subarachnoid Haemorrhage

Beta-Cell Dysfunction and Insulin Resistance after Subarachnoid Haemorrhage

Prevention and treatment of medical and neurological complications in patients with aneurysmal subarachnoid haemorrhage

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