Abstract Details

Title Radiological Severity Determines Glycemic Burden In Aneurysmal Subarachnoid Hemorrhage And Patient Outcome

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-044

Objective

Determine whether glycemic burden (GB) is dependent on presenting disease severity and investigate its role in in-hospital morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH).

Background

Altered homeostasis like admission hyperglycemia is a common systemic response in aSAH. We previously reported dose-dependent hyperglycemia to be associated with admission disease severity. It is also reported that both post-operative hyperglycemia and systemic glucose fluctuations are deleterious in acute brain injury. The present study investigates temporal GB and glycemic burden variability (GBV) and their respective role in-hospital morbidity and mortality in aSAH patients.

Design/Methods This retrospective study reviewed charts of aSAH patients admitted to a tertiary care hospital over a 5-year-period. Daily GB during the first 7 days of admission was calculated using difference between bedside glucose level and HbA1c derived premorbid glucose level. Coefficient of variance (CeOV) was used to determine GBV. Parametric(t-test) and non-parametric (rank test) tests were used to examine the GB and GBV difference by disease severity, DCI and discharge status.

Results 142 patients met inclusion criteria. Patients with higher modified Fisher score (mFS) of 3-4 had higher GBV as compared to those with low mFS [0.17vs.0.21, p=0.013]. However, admission World Federation of Neurosurgeons’ scale (WFNS) was not associated with GBV [WFNS 1-3 vs. WFNS 4-5=0.191 vs. 0.201, p=0.52]. There were significant overall differences in average GB and GBV among diabetic and non-diabetic patients (ANOVA p-value<0.0001). Patients with in-hospital mortality had higher GB and GBV as compared to those discharged home or to rehabilitation [mean difference 13.9, 95% CI(1.1-26.2), p=0.03 and 0.045, 95% CI(-0.001-0.090), p=0.057 respectively]. No statistical difference was identified with GB or GBV in patients developing DCI.

Conclusions

Association of higher radiological grade, indicating higher intracranial clot volume, alludes to a role of neurohumoral response that needs quantitative characterization. Patients with diabetes mellitus have worse dysglycemia and increased mortality after aSAH.

Authors/Disclosures
Syeda Dania Shujaat, MD, MBBS (Hartford Hospital) PRESENTER	No disclosure on file
Syeda Maria Muzammil, MD (RUMC-Neurology)	Dr. Muzammil has nothing to disclose.
Claire E. Delpirou Nouh, MD (University of Oklahoma Health Science Center, Department of Neurology)	The institution of Dr. Delpirou Nouh has received research support from Oklahomas Nathan Shock Center. Dr. Delpirou Nouh has a non-compensated relationship as a Volunteer/Board member with Oklahoma Alzheimer Association that is relevant to AAN interests or activities.
Chao Xu	Chao Xu has nothing to disclose.
Bappaditya Ray, MD (UT Southwestern Medical Center)	Dr. Ray has nothing to disclose.

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