Hyperglycemia Aggravates Cerebral Vasospasm after Subarachnoid Hemorrhage in a Rat Model

Huang, Yuhua; Chung, Chia-Li; Tsai, Hung-Pei; Wu, Shao-Chun; Chang, Chih-Zen; Chai, Chee‐Yin; Lee, Tao-Chen; Kwan, Aij‐Lie

doi:10.1093/neuros/nyx016

Cited by 30 publications

(19 citation statements)

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“…[ 15 ] In our experimental study, hyperglycemia-preconditioned rats had worse neurological functions following SAH than those with either hyperglycemia or SAH alone, which reinforced clinical findings. [ 16 ] It is reasonable to hypothesize that factors affecting the prognosis of patients following SAH also may be responsible for an increased risk of tracheotomy, and the connection between diabetes mellitus and tracheostomy shown in this study seems not surprising. The acute phase of stroke is usually accompanied by a humoral surge in cortisol and catecholamines, [ 17 ] which results in elevated blood glucose levels regardless of a previous diabetes diagnosis.…”

Section: Discussionmentioning

confidence: 74%

Characterization of tracheotomized patients after spontaneous subarachnoid hemorrhage

et al. 2020

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Spontaneous subarachnoid hemorrhage (SAH) is a catastrophic event with high disability and fatality rates. Post-SAH survivors may require prolonged intubation with the assistance of mechanical ventilators, and some patients will undergo tracheostomy to facilitate their pulmonary hygiene and airway protection. The aim of this study is to identify the incidence and risk factors of the need for tracheostomy after spontaneous SAH. We used a retrospective approach and enrolled 838 adult patients with a primary diagnosis of spontaneous SAH who survived >7 days after hospitalization. Medical information was retrieved from the administrative database utilizing diagnostic and procedure codes by the International Classification of Diseases, Ninth Revision, Clinical Modification. Patients with first-ever SAH included 329 men and 509 women, and their average age was 56.9 ± 14.4 years, ranging between 18 and 91 years. Fifty-eight of these 838 patients underwent tracheostomy procedures, and the overall incidence was 6.9%. In a multivariate logistic regression model, the independent risk factors of the need for tracheostomy were underlying diabetes mellitus ( P = .02), hydrocephalus ( P < .01), and pneumonia ( P < .01). The mean duration of hospital stay was 26.0 ± 15.3 and 16.8 ± 12.2 days for patients with and without a tracheostomy, respectively ( P < .01). In conclusion, a significant percentage of post-SAH survivors underwent tracheostomy during acute hospitalization. Attention to independent risk factors, including preexisting diabetes mellitus, concomitant hydrocephalus, and nosocomial pneumonia, is essential for timely patient selection for tracheostomy.

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Section: Discussionmentioning

confidence: 74%

Characterization of tracheotomized patients after spontaneous subarachnoid hemorrhage

et al. 2020

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“…70 Hyperglycemia increases the chance of cerebral vasospasm after SAH, mainly through the NO pathway as a potential underlying mechanism via the dysregulation of eNOS and iNOS. 71 A study found that aminoguanidine inhibits iNOS activity and reduces cerebral vasospasm after SAH in rabbits after abnormal endothelial cell repair. 72 …”

Section: Echanisms Of No In Smentioning

confidence: 99%

The role of nitric oxide in stroke

et al. 2017

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Stroke is considered to be an acute cerebrovascular disease, including ischemic stroke and hemorrhagic stroke. The high incidence and poor prognosis of stroke suggest that it is a highly disabling and highly lethal disease which can pose a serious threat to human health. Nitric oxide (NO), a common gas in nature, which is often thought as a toxic gas, because of its intimate relationship with the pathological processes of many diseases, especially in the regulation of blood flow and cell inflammation. However, recent years have witnessed an increased interest that NO plays a significant and positive role in stroke as an essential gas signal molecule. In view of the fact that the neuroprotective effect of NO is closely related to its concentration, cell type and time, only in the appropriate circumstances can NO play a protective effect. The purpose of this review is to summarize the roles of NO in ischemic stroke and hemorrhagic stroke.

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“…Moreover, hyperglycemia provides an abundant substrate for anaerobic glycolysis in ischemic brain tissue, which leads to excessive lactate accumulation, acidosis, and cell death [34]. In a rat SAH model, hyperglycemia exacerbated cerebral vasospasm by dysregulating endothelial nitric oxide synthase (eNOS) and inducing nitric oxide synthase (iNOS) [35]. Another experimental study indicated that hyperglycemia may activate the extrinsic caspase cascade through the extracellular regulated kinase (ERK) signal pathway to contribute to neuronal apoptosis after SAH [36].…”

Section: Discussionmentioning

confidence: 99%

Serum glucose as an important predictor of delayed cerebral ischemia in angiogram-negative subarachnoid hemorrhage

Zhang

Wang

et al. 2021

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Background Despite benign overall course, angiogram-negative subarachnoid hemorrhage (AN-SAH) still companies with risk of delayed cerebral ischemia (DCI). Serum glucose was previously found to be related to DCI occurrence in aneurysmal subarachnoid hemorrhage (aSAH), but this has not been confirmed in AN-SAH. The aim of this study was to clarify the significance of serum glucose in DCI prediction in AN-SAH patients. Methods We included patients with AN-SAH admitted to our hospital between January 2013 and December 2018. According to different bleeding patterns, patients were divided into perimesencephalic AN-SAH (PAN-SAH) and non-perimesencephalic AN-SAH (NPAH-SAH) patients. DCI was defined as symptomatic vasospasm or/and delayed cerebral infarction. A statistical analysis of the clinical, radiological, and laboratory risk factors of DCI was conducted. Logistic regression analysis was performed to identify the independent predictors of DCI. Results A total of 244 AN-SAH patients (mean age 55.7 years, 55.7% men) were included with 164 (67.2%) PAN-SAH patients and 80 (32.8%) NPAN-SAH patients. There were significant correlations between high DCI incidence and high serum glucose levels in the first five days after admission in both PAN-SAH patients and NPAN-SAH patients (p < 0.05). High admission serum glucose was significantly related to higher World Federation of Neurosurgeons Scale (WFNS) (p < 0.05). Multivariate logistic regression analysis showed that admission serum glucose (p = 0.001, OR 1.705, 95% CI 1.232–2.360) and WFNS (p = 0.008, OR 2.889, 95% CI 1.322–6.311) were both significant and independent predictors for DCI occurrence in PAN-SAH patients. Admission serum glucose (p = 0.016, OR 2.307, 95% CI 1.167–4.562), standard deviation (SD) of the serum glucose in the first three days after admission (p = 0.049, OR 5.684, 95% CI 1.006–32.114) and modified Fisher scale (mFS) (p = 0.033, OR 1.859, 95% CI 1.051–3.288) were significant and independent predictors for DCI occurrence in NPAN-SAH patients. Conclusions Serum glucose is an early biomarker to predict DCI risk in both PAN-SAH and NPAN-SAH patients, which has an important value in guiding intensive care in AN-SAH patients.

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Hyperglycemia Aggravates Cerebral Vasospasm after Subarachnoid Hemorrhage in a Rat Model

Abstract: Hyperglycemia exacerbated cerebral vasospasm and was associated with poorer neurological outcomes following SAH. Our findings also suggested the nitric oxide pathway as a potential underlying mechanism via the dysregulation of eNOS and iNOS.

Cited by 30 publications

References 32 publications

Characterization of tracheotomized patients after spontaneous subarachnoid hemorrhage

Characterization of tracheotomized patients after spontaneous subarachnoid hemorrhage

The role of nitric oxide in stroke

Serum glucose as an important predictor of delayed cerebral ischemia in angiogram-negative subarachnoid hemorrhage

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