Abstract Details

Title Role of Glycemic Burden and Glycemic Burden Variability in Determination of Temporary and Permanent Cerebrospinal Fluid diversion after Aneurysmal Subarachnoid Hemorrhage

Topic Neuro Trauma, Critical Care, and Sports Neurology

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

Poster/Presentation
Number 4-047

Objective Determine whether glycemic burden (GB) and glycemic burden variability (GBV) predicts temporary and permanent cerebrospinal fluid (CSF) diversion procedures after aneurysmal subarachnoid hemorrhage (aSAH).

Background Patients with aSAH are at increased risk of developing post-hemorrhagic hydrocephalus (PHH) and often require temporary and permanent CSF diversion using external ventricular drain (EVD) and ventriculoperitoneal shunt (VPS). Role of admission hyperglycemia in EVD and VPS placement has been investigated and results are conflicting. GB and GBV are reported as more accurate markers to assess derangement of glucose homeostasis and to study deleterious effect of hyperglycemia after acute brain injury.

Design/Methods Retrospective chart review was conducted in aSAH patients admitted to a tertiary care hospital over a 5-year period. Daily GB during the first 7 days of admission was calculated by using the difference between bedside glucose level and HbA1c derived premorbid glucose level. Coefficient of variance (CeOV) was used to determine GBV during these days. Age dependent bicaudate index (BCI) on admission CT scan of head determined PHH. We used both parametric (t-test) and non-parametric (rank test) test to examine the GB and GBV difference by disease severity, delayed cerebral ischemia (DCI) and discharge status.

Results 142 patients met the inclusion criteria. Patients with higher modified Fisher score (mFS) of 3-4 had higher GBV as compared to those with low mFS [0.17 vs. 0.21, p=0.013]. Ninety-nine (69.7%) patients required EVD placement at the time of presentation while 21/139 (15.1%) required VPS. GB was not associated with VPS placement with or without control for higher mFS of 3-4 or age >65 years (ANOVA p-value 0.352 and 0.352 respectively). Similarly, GBV was also not associated with VPS placement (ANOVA p-value 0.282 and 0.283 respectively).

Conclusions Permanent CSF diversion after aSAH is not solely dependent on post-hemorrhagic dysglycemia and thus alludes to a multifactorial etiology.

Authors/Disclosures
Syeda Maria Muzammil, MD (RUMC-Neurology) PRESENTER	Dr. Muzammil has nothing to disclose.
Syeda Dania Shujaat, MD, MBBS (Hartford Hospital)	No disclosure on file
Bappaditya Ray, MD (UT Southwestern Medical Center)	Dr. Ray has nothing to disclose.
Chao Xu	Chao Xu 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.
	No disclosure on file

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