Initial hyperglycemia as an indicator of severity of the ictus in poor-grade patients with spontaneous subarachnoid hemorrhage
Initial hyperglycemia as an indicator of severity of the ictus in poor-grade patients with spontaneous subarachnoid hemorrhage
复制标题
DOI：
10.1016/s0303-8467(00)00067-6
复制
发表时间：
2000-06-01
影响因子：
1.9
通讯作者：
Bertalanffy, H
中科院分区：
文献类型：
--
作者：
Alberti, O;Becker, R;Bertalanffy, H
高血糖与自发性蛛网膜下腔出血（SAH）结局之间的相关性偶有报道。我们的假设是，高血糖症是中枢代谢紊乱的一个迹象，与计算机断层扫描（CT）上反映相应脑损伤不同程度的特定表现有关。入院时血糖水平。在Hunt & Hess分级为IV或V的99名SAH患者的队列中分析了初始CT结果和6个月后的结果。定量评估了蛛网膜下腔血、脑内血肿、脑室内出血、脑积水、中线移位和中脑周围脑池压缩的CT扫描。结合这些结果确定三点CT严重程度评分。所有患者入院时血糖水平均升高（> 5.8 mmol/l）。33例血糖<9.0mmol/l者病死率为33.3%，45例血糖在9.0 ~ 13.0mmol/l者病死率为71.1%，21例血糖> 13.0mmol/l者病死率为95.2%（P < 0.0001）。V级患者的葡萄糖水平高于IV级患者（平均值+/- SD）（11.5 +/- 3.2 vs 9.8 +/- 2.9 mmol/l; P = 0.0012）。CT表现为轻度的患者（n = 10）血糖水平最低（8.9 ± 1.8 mmol/l; P = 0.0082），而CT表现为重度的患者（n = 56）血糖水平最高（11.4 ± 3.5 mmol/l：P = 0.011）。尽管与临床分级和CT表现的程度相关，Logistic多元回归分析显示入院时血糖水平是预后的独立指标。初始血糖水平的预后潜力可能有利于低级别SAH患者的管理方案。(C)2000 Elsevier Science B. V.保留所有权利。
An association between hyperglycemia and outcome in spontaneous subarachnoid hemorrhage (SAH) has been sporadically reported. Our hypothesis was that hyperglycemia is a sign of central metabolic disturbance linked with specific appearances on computerized tomography (CT) scans reflecting different degrees of corresponding brain injury. The admission plasma glucose level. initial CT findings, and outcome after 6 months were analysed in a cohort of 99 patients with SAH in Hunt & Hess Grade IV or V. The CT scans were quantitatively assessed for subarachnoid blood, intracerebral hematoma, intraventricular hemorrhage, hydrocephalus, midline shift and compression of the perimesencephalic cisterns. These findings were combined to determine a three-point CT severity score. All patients showed elevated (> 5.8 mmol/l) plasma glucose levels on admission. Mortality among 33 patients with glucose concentration below 9.0 mmol/l was 33.3%, 71.1% for the 45 patients with glucose level between 9.0 and 13.0 mmol/l, and 95.2% for the 21 patients with concentration above 13.0 mmol/l (P < 0.0001). Glucose level was higher in Grade V than in Grade IV patients (mean +/- SD) (11.5 +/- 3.2 vs 9.8 +/- 2.9 mmol/l; P = 0.0012). Patients with mild CT findings (n = 10) had the lowest glucose level (8.9 +/- 1.8 mmol/l; P = 0.0082), whereas patients with severe findings (n = 56) had the highest glucose (11.4 +/- 3.5 mmol/l: P = 0.011). Despite association with clinical grade and extent of CT findings, logistic multiple regression revealed the admission plasma glucose level to be an independent prognosticator of outcome. The prognostic potential of the initial plasma glucose level may be beneficial in management protocols of poor-grade SAH patients. (C) 2000 Elsevier Science B.V. All rights reserved.