Relationship between hyperglycemia and symptomatic vasospasm after subarachnoid hemorrhage*

Tight glycemic control (TGC) has emerged as a major research focus in critical care due to its potential to simultaneously reduce both mortality and costs. However, repeating initial successful TGC trials that reduced mortality and other outcomes has proven difficult with more failures than successes. Hence, there has been growing debate over the necessity of TGC, its goals, the risk of severe hypoglycemia, and target cohorts.This paper provides a review of TGC via new analyses of data from several clinical trials, including SPRINT, Glucontrol and a recent NICU study. It thus provides both a review of the problem and major background factors driving it, as well as a novel model-based analysis designed to examine these dynamics from a new perspective. Using these clinical results and analysis, the goal is to develop new insights that shed greater light on the leading factors that make TGC difficult and inconsistent, as well as the requirements they thus impose on the design and implementation of TGC protocols.A model-based analysis of insulin sensitivity using data from three different critical care units, comprising over 75,000 hours of clinical data, is used to analyse variability in metabolic dynamics using a clinically validated model-based insulin sensitivity metric (S I ). Variation in S I provides a new interpretation and explanation for the variable results seen (across cohorts and studies) in applying TGC. In particular, significant intra-and inter-patient variability in insulin resistance (1/ S I ) is seen be a major confounder that makes TGC difficult over diverse cohorts, yielding variable results over many published studies and protocols. Further factors that exacerbate this variability in glycemic outcome are found to include measurement frequency and whether a protocol is blind to carbohydrate administration.

show abstract

“…• Mortality increases with mean, maximum, and minimum and/or range of blood glucose in a range of cohorts [6][7][8][56][57][58][59].…”

Section: The Interrelationship Of Glycemia Tgc Patients and Outcomementioning

confidence: 99%

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Chase

Compte

Suhaimi

et al. 2011

Computer Methods and Programs in Biomedicine

119

View full text Add to dashboard Cite

show abstract

“…Patients with hyperglycemia on admission or during the clinical course develop DCI and cerebral infarction more often than patients with normal blood glucose levels (Badjatia et al, 2005;Charpentier et al, 1999;Frontera et al, 2006;Juvela et al, 2005;Kruyt et al, 2008;Lanzino, 2005). The association between admission hyperglycemia and DCI was weaker than that of persistent hyperglycemia and DCI, and the association between admission glucose and DCI did not persist after multivariable assessment in several studies (Badjatia et al, 2005;Frontera et al, 2006;Juvela et al, 2005;Kruyt et al, 2008). The fact that aSAH patients with preexistent DM are at an increased risk of DCI compared with aSAH patients without preexistent DM lends further support of a link between abnormalities of glucose metabolism and DCI in aSAH patients Fergusen and Macdonald, 2007).…”

Section: How Does Hyperglycemia Affect Outcome After Aneurysmal Subarmentioning

confidence: 99%

“…The DCI occurs in approximately one third of aSAH patients, mostly between days 4 and 10 (Roos et al, 2000) and can progress to irreversible cerebral infarction with subsequent poor clinical outcome (Rosengart et al, 2007). Patients with hyperglycemia on admission or during the clinical course develop DCI and cerebral infarction more often than patients with normal blood glucose levels (Badjatia et al, 2005;Charpentier et al, 1999;Frontera et al, 2006;Juvela et al, 2005;Kruyt et al, 2008;Lanzino, 2005). The association between admission hyperglycemia and DCI was weaker than that of persistent hyperglycemia and DCI, and the association between admission glucose and DCI did not persist after multivariable assessment in several studies (Badjatia et al, 2005;Frontera et al, 2006;Juvela et al, 2005;Kruyt et al, 2008).…”

Section: How Does Hyperglycemia Affect Outcome After Aneurysmal Subarmentioning

confidence: 99%

“…Studies that report on glucose levels during the first 1 or 2 weeks of the clinical course report that hyperglycemia persists with levels exceeding 7 to 8 mmol/L (Badjatia et al, 2005;Dorhout Mees et al, 2003;Frontera et al, 2006;Kruyt et al, 2008;Lanzino et al, 1993).…”

Section: Mechanisms Leading To Hyperglycemia After Aneurysmal Subaracmentioning

confidence: 99%

“…Besides neurologic complications, patients with aSAH often have cardiopulmonary and general medical complications that can influence outcome. Hyperglycemia in aSAH patients is common and associated with poor clinical outcome (Badjatia et al, 2005;Charpentier et al, 1999;Dorhout Mees et al, 2003;Frontera et al, 2006;Kruyt et al, 2008Kruyt et al, , 2009Lanzino et al, 1993). As treatment for hyperglycemia is available, it has attracted increasing attention as a target for intervention, although adequate and safe glycemic control is difficult to achieve in patients with aSAH.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hyperglycemia in Aneurysmal Subarachnoid Hemorrhage: A Potentially Modifiable Risk Factor for Poor Outcome

Kruyt

Biessels

DeVries

et al. 2010

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

Hyperglycemia after aneurysmal subarachnoid hemorrhage (aSAH) occurs frequently and is associated with delayed cerebral ischemia (DCI) and poor clinical outcome. In this review, we highlight the mechanisms that cause hyperglycemia after aSAH, and we discuss how hyperglycemia may contribute to poor clinical outcome in these patients. As hyperglycemia is potentially modifiable with intensive insulin therapy (IIT), we systematically reviewed the literature on IIT in aSAH patients. In these patients, IIT seems to be difficult to achieve in terms of lowering blood glucose levels substantially without an increased risk of (serious) hypoglycemia. Therefore, before initiating a large-scale randomized trial to investigate the clinical benefit of IIT, phase II studies, possibly with the help of cerebral blood glucose monitoring by microdialysis, will first have to improve this therapy in terms of both safety and adequacy.

show abstract

Poor expression of miR‐195‐5p can assist the diagnosis of cerebral vasospasm after subarachnoid hemorrhage and predict adverse outcomes

et al. 2022

View full text Add to dashboard Cite

Objective: Patients with spontaneous subarachnoid hemorrhage (SAH) may develop refractory arterial cerebral vasospasm (CVS), which is the leading cause of death in SAH patients. This study explored the clinical diagnostic value of serum miR-195-5p levels in CVS after SAH (SAH + CVS) and its relationship with the prognosis of SAH + CVS. Methods: A total of 110 patients with spontaneous SAH were divided into the SAH group (N = 62) and SAH + CVS group (N = 58), with 60 healthy subjects as controls. The clinical data of blood glucose, blood sodium fluctuation, and serum lactic acid were recorded. miR-195-5p serum level was detected by RT-qPCR and its diagnostic value on SAH + CVS was analyzed by receiver operating characteristic curve. Serum levels of PDGF/IL-6/ET-1 and their correlation with miR-195-5p were analyzed using RT-qPCR, enzyme-linked immunosorbent assay, and Pearson's method. The patient prognosis was evaluated by Glasgow Outcome Scale. The effect of miR-195-5p levels on adverse prognosis was analyzed by Kaplan-Meier method and Cox regression analysis. Results: miR-195-5p was lowly expressed in the serum of SAH patients and lower in SAH + CVS patients. Serum miR-195-5p level assisted the diagnosis of SAH and SAH+ CVS and was negatively correlated with PDGF/IL-6/ET-1 levels and was an independent risk factor together with ET-1 and blood glucose for SAH + CVS. miR-195-5p low expression predicted a higher cumulative incidence of adverse outcomes and was an independent predictor of adverse outcomes. Conclusion:Poor expression of miR-195-5p can assist the diagnosis of SAH + CVS and predict higher adverse outcomes.

show abstract

Relationship between hyperglycemia and symptomatic vasospasm after subarachnoid hemorrhage*

Abstract: Mean inpatient blood glucose value is associated with the development of VSP and may represent a target for therapy to prevent VSP and improve clinical outcomes.

Cited by 140 publications

References 55 publications

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Tight glycemic control in critical care – The leading role of insulin sensitivity and patient variability: A review and model-based analysis

Hyperglycemia in Aneurysmal Subarachnoid Hemorrhage: A Potentially Modifiable Risk Factor for Poor Outcome

Poor expression of miR‐195‐5p can assist the diagnosis of cerebral vasospasm after subarachnoid hemorrhage and predict adverse outcomes

Contact Info

Product

Resources

About