Admission Hyperglycemia Predicts Long-Term Mortality in Critically Ill Patients With Subarachnoid Hemorrhage: A Retrospective Analysis of the MIMIC-III Database

Abstract

Subarachnoid hemorrhage (SAH) is a severe subtype of stroke with high mortality. Hyperglycemia is a common phenomenon in critically ill patients and associated with poor clinical outcome. However, the predictive value of admission hyperglycemia for 30 and 90-day all-cause mortality in critically ill patients with SAH remains controversial. All SAH patients between 2001 and 2012 were included based on the MIMIC-III database and were further classified according to the tertiles of blood glucose (BG) measured on intensive care unit (ICU) admission. Clinical information including demographic data, comorbidities, and laboratory indicators were exacted and analyzed. The primary outcomes were 30- and 90-day all-cause mortality. A total of 1,298 SAH patients were included. The 30 and 90-day mortality rates were 19.80% and 22.73%, respectively. Subjects in the high glucose tertile were older, were overweight, had higher sequential organ failure assessment (SOFA) and Simplified Acute Physiology Score II (SAPS II) scores, and presented higher mortality rate. Generalized additive model revealed a U-shaped relationship between BG and 30 and 90-day all-cause mortality. Furthermore, Kaplan–Meier (K-M) survival curve also illustrated that subjects with admission hyperglycemia presented lower survival rate and shorter survival time. In Cox analysis, after adjustment for potential confounders, admission hyperglycemia was related to an increase in 30- and 90-day all-cause mortality in SAH patients. In subgroup analysis, the association between admission hyperglycemia and all-cause mortality was consistent. In conclusion, admission hyperglycemia is associated with significantly increased 30- and 90-day all-cause mortality in critically ill patients with SAH.

Multimodal imaging of the role of hyperglycemia following experimental subarachnoid hemorrhage

“…These results agree with clinical studies showing an association between glucose burden and serious hospital complications, longer length of intensive care unit stay, and increased risk of death or severe disability after SAH. 14,42 Accordingly, the induction of SH in our study led to high mortality rates ranging from 68 to 82% during the first 72 hours after experimental SAH, limiting the utility of high-glycemic experimental conditions to assess the effect of hyperglycemia in SAH outcome beyond the first 24 hours.…”

Relationship between the mean of 24-h venous blood glucose and in-hospital mortality among patients with subarachnoid hemorrhage: A matched cohort study

“…The reasons why we used average BG in this study are as follows. First, previous studies have demonstrated that high BG is common in CPs (12,(20)(21)(22)(23). Frontera et al retrospectively completed a cohort study of 281 SAH sufferers and found that high BG posterior to SAH was related to severe complicating diseases, more ICU stay, and elevated risk of death or serious disability (8).…”

“…. (12). Moreover, statistically, Eagles et al discovered a remarkable reduction in unsatisfactory prognoses among SAH sufferers maintaining the maximal BG contents lower than a determined best cutoff of 9.2 mmol/L (13).…”

“…High blood glucose (BG) is common in critically ill patients (CPs), and the association between admission high BG and death rate was broadly researched as well. Liu et al revealed that admission BG > 142.00 mg/dl (7.91 mmol/L) was related to elevated risks of modified 30- and 90-day all-cause mortality (ACM) in CPs ( 12 ). Moreover, statistically, Eagles et al discovered a remarkable reduction in unsatisfactory prognoses among SAH sufferers maintaining the maximal BG contents lower than a determined best cutoff of 9.2 mmol/L ( 13 ).…”

Clinical relevance of glucose metrics during the early brain injury period after aneurysmal subarachnoid hemorrhage: An opportunity for continuous glucose monitoring

“…First, hyperglycaemia has been associated with worse clinical and radiological presentation, as well as with higher in-hospital mortality, higher rates of neurological and systemic complications, and ultimately worse short-term and long-term functional outcomes ( 3 , 5 , 7 , 14 , 16 , 54 – 62 , 64 – 66 ). On the other hand, hypoglycaemia has been strongly linked to in-hospital mortality and incidence of vasospasm ( 55 , 59 , 61 – 63 ). Otherwise, poor premorbid metabolic control estimated by HbA1c upon admission does not seem to consistently correlate with the acute neurological status nor with DCI or neurological outcome at long-term ( 64 , 65 ).…”