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Strict glucose control does not affect mortality after aneurysmal subarachnoid hemorrhage
Robert H Thiele1, Nader Pouratian, Zhiyi Zuo
1Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
Anesthesiology
|February 20, 2009
Summary
Strict glucose control in neurologic injury patients lowered average glucose but did not affect mortality. However, it increased hypoglycemia, which significantly raised the risk of death.
Area of Science:
- Neurology
- Critical Care Medicine
- Endocrinology
Background:
- Hyperglycemia and hypoglycemia negatively impact patients with neurologic injuries.
- Maintaining optimal blood glucose levels is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the impact of a strict glucose control protocol on patients with aneurysmal subarachnoid hemorrhage.
- To assess the effects of tight glucose control on mortality and hypoglycemia incidence.
Main Methods:
- Implementation of a strict glucose control protocol (goal glucose < 120 mg/dl) in a neurointensive care unit.
- Analysis of in-hospital mortality, admission glucose, and average glucose levels before and after protocol implementation.
- Multivariate analysis to determine the association of glucose levels and hypoglycemia with mortality.
Main Results:
- The strict glucose control protocol reduced average glucose levels and the incidence of hyperglycemia.
- In-hospital mortality rates remained unchanged (11.7% vs. 12.0%).
- Protocol implementation was associated with an increased incidence of hypoglycemia, which significantly increased the risk of death (odds ratio = 3.818).
Conclusions:
- A tight glucose control regimen effectively lowers average glucose levels in neurocritical care patients.
- This protocol did not improve overall in-hospital mortality but increased hypoglycemia risk.
- The increased risk of death associated with hypoglycemia warrants careful consideration when implementing strict glucose control.
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