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Value of Glycemic Indices for Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: A Retrospective
Matthias Manfred Deininger1, Miriam Weiss2,3, Stephanie Wied4
1Department of Intensive and Intermediate Care, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany.
Insights
Elevated blood glucose levels, including time-weighted average glucose and a novel dysglycemic rate, were significantly higher in aneurysmal subarachnoid hemorrhage patients who developed delayed cerebral ischemia. These glucose indices may help identify at-risk patients and aid in early DCI detection.
Area of Science:
- Neurology
- Critical Care Medicine
- Endocrinology
Background:
- Delayed cerebral ischemia (DCI) is a serious complication of aneurysmal subarachnoid hemorrhage (aSAH), leading to poor outcomes.
- Early DCI detection is challenging but critical for patient management.
- Blood glucose dysregulation is common after aSAH and may contribute to DCI development.
Purpose of the Study:
- To investigate the association between glucose indices and DCI in aSAH patients.
- To determine if glycemic parameters can identify patients at risk for DCI.
- To assess the utility of glucose indices for improving DCI detection.
Main Methods:
- Retrospective observational study of 151 aSAH patients (2016-2019).
- Analysis of glycemic indices, including time-weighted average glucose (TWAG) and time-unified dysglycemic rate (TUDR140), before and after DCI onset.
- Comparison of glucose indices between patients who developed DCI and those who did not.
Main Results:
- Patients who developed DCI had significantly higher TWAG, mean blood glucose, and TUDR140 in the pre-DCI period compared to the no-DCI group.
- Significant increases in TWAG and TUDR140 were observed at the onset of DCI.
- Elevated blood glucose levels were present before DCI and increased further at its onset.
Conclusions:
- DCI patients exhibit altered blood glucose profiles, with elevated levels preceding and peaking at DCI onset.
- Glucose indices show potential as biomarkers for identifying DCI risk and facilitating earlier detection.
- Further prospective studies are required to validate these findings and explore their clinical application in multiparametric models.
Abstract:
Delayed cerebral ischemia (DCI) is a severe complication following aneurysmal subarachnoid hemorrhage (aSAH), linked to poor functional outcomes and prolonged intensive care unit (ICU) stays. Timely DCI diagnosis is crucial but remains challenging. Dysregulated blood glucose, commonly observed after aSAH, may impair the constant glucose supply that is vital for brain function, potentially contributing to DCI. This study aimed to assess whether glucose indices could help identify at-risk patients and improve DCI detection. This retrospective, single-center observational study examined 151 aSAH patients between 2016 and 2019. Additionally, 70 of these (46.4%) developed DCI and 81 did not (no-DCI). To determine the value of glycemic indices for DCI, they were analyzed separately in patients in the period before (pre-DCI) and after DCI (post-DCI). The time-weighted average glucose (TWAG, p = 0.024), mean blood glucose (p = 0.033), and novel time-unified dysglycemic rate (TUDR140, calculated as the ratio of dysglycemic to total periods within a glucose target range of 70-140 mg/dL, p = 0.042), showed significantly higher values in the pre-DCI period of the DCI group than in the no-DCI group. In the time-series analysis, significant increases in TWAG and TUDR140 were observed at the DCI onset. In conclusion, DCI patients showed elevated blood glucose levels before and a further increase at the DCI onset. Prospective studies are needed to confirm these findings, as this retrospective, single-center study cannot completely exclude confounders and limitations. In the future blood glucose indices might become valuable parameters in multiparametric models to identify patients at risk and detect DCI onset earlier.
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