Effect of stress-induced hyperglycemia after non-traumatic non-aneurysmal subarachnoid hemorrhage on clinical complications and functional outcomes.
Effect of stress-induced hyperglycemia after non-traumatic non-aneurysmal subarachnoid hemorrhage on clinical complications and functional outcomes.
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DOI：
10.1111/cns.13826
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发表时间：
2022-06
影响因子：
5.5
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中科院分区：
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尽管病程总体呈良性，但非创伤性非动脉瘤性蛛网膜下腔出血（naSAH）仍然伴随着临床并发症和不良预后的风险。 naSAH 后并发症和不良结局的危险因素和机制仍不清楚。我们的目的是探讨应激性高血糖 (SIH) 对 naSAH 患者并发症发生率和功能结果的影响。我们对 2013 年至 2018 年间收治的 naSAH 患者进行回顾性分析。SIH 根据之前的标准进行识别。症状性血管痉挛、迟发性脑梗塞和脑积水被确定为主要并发症。使用改良的兰金量表 (mRS) 在出院时、3 个月和 12 个月时对结果进行评估。进行统计分析以揭示 SIH 与并发症和结果的关联。该队列共有 244 名 naSAH 患者，其中 74 名 SIH（30.3%）。调整年龄、性别、高血压、Hunt and Hess (HH) 分级、改良 Fisher 量表 (mFS)、脑室内出血 (IVH) 和蛛网膜下腔血液分布后，SIH 与症状性血管痉挛 (p < 0.001, 12.176 [4.904–30.231])、迟发性脑梗死 (p < 0.001, 12.434 [3.850–40.161]）、脑积水（p = 0.008、5.771 [1.570–21.222]）和 12 个月时预后不良（p = 0.006、5.506 [1.632–18.581]），而 SIH 与出院时不良预后之间的相关性(p = 0.064, 2.409 [0.951–6.100]) 或 3 个月 (p = 0.110, 2.029 [0.852–4.833]) 不显着。 SIH 的纳入增加了预测症状性血管痉挛 (p = 0.002)、迟发性脑梗死 (p = 0.024)、脑积水 (p = 0.037) 和 12 个月不良预后 (p = 0.087) 的组合模型中 ROC 的曲线下面积 (AUC)。 SIH是naSAH患者症状性血管痉挛、迟发性脑梗死、脑积水和长期不良预后的重要且独立的危险因素。 naSAH 后及早识别 SIH 对于决策和治疗计划非常重要。这是第一项探讨 SIH 对 naSAH 患者并发症发生率和功能结果影响的研究。本研究发现SIH是naSAH患者症状性血管痉挛、迟发性脑梗死、脑积水和长期不良预后的显着且独立的危险因素。
Despite having an overall benign course, non‐traumatic non‐aneurysmal subarachnoid hemorrhage (naSAH) is still accompanied by a risk of clinical complications and poor outcomes. Risk factors and mechanisms of complications and poor outcomes after naSAH remain unknown. Our aim was to explore the effect of stress‐induced hyperglycemia (SIH) on complication rates and functional outcomes in naSAH patients. We retrospectively reviewed patients with naSAH admitted to our institution between 2013 and 2018. SIH was identified according to previous criterion. Symptomatic vasospasm, delayed cerebral infarction, and hydrocephalus were identified as main complications. Outcomes were reviewed using a modified Rankin Scale (mRS) at discharge, 3 months, and 12 months. A statistical analysis was conducted to reveal the associations of SIH with complications and outcomes. A total of 244 naSAH patients were included in the cohort with 74 (30.3%) SIH. After adjusting for age, gender, hypertension, Hunt and Hess (HH) grade, modified Fisher Scale (mFS), intraventricular hemorrhage (IVH), and subarachnoid blood distribution, SIH was significantly associated with symptomatic vasospasm (p < 0.001, 12.176 [4.904–30.231]), delayed cerebral infarction (p < 0.001, 12.434 [3.850–40.161]), hydrocephalus (p = 0.008, 5.771 [1.570–21.222]), and poor outcome at 12 months (p = 0.006, 5.506 [1.632–18.581]), whereas the correlation between SIH and poor outcome at discharge (p = 0.064, 2.409 [0.951–6.100]) or 3 months (p = 0.110, 2.029 [0.852–4.833]) was not significant. Incorporation of SIH increased the area under curve (AUC) of ROC in the combined model for predicting symptomatic vasospasm (p = 0.002), delayed cerebral infarction (p = 0.024), hydrocephalus (p = 0.037), and 12‐month poor outcome (p = 0.087). SIH is a significant and independent risk factor for symptomatic vasospasm, delayed cerebral infarction, hydrocephalus, and long‐term poor outcome in naSAH patients. Identifying SIH early after naSAH is important for decision‐making and treatment planning. This is the first study to explore the effect of SIH on complication rates and functional outcomes in naSAH patients. This study found that SIH was a significant and independent risk factor for symptomatic vasospasm, delayed cerebral infarction, hydrocephalus, and long‐term poor outcome in naSAH patients.
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影响因子：
2
作者：
Kim, Myungsoo;Kim, Byoung-Joon;Kang, Dong-Hun
通讯作者：
Kang, Dong-Hun
影响因子：
6.7
作者：
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通讯作者：
Van Velthoven, Vera
影响因子：
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作者：
Gupta, Sunil K.;Gupta, Rahul;Mathuriya, Suresh N.
通讯作者：
Mathuriya, Suresh N.
影响因子：
1.9
作者：
Alberti, O;Becker, R;Bertalanffy, H
通讯作者：
Bertalanffy, H
影响因子：
4.1
作者：
Juvela, S;Siironen, J;Kuhmonen, J
通讯作者：
Kuhmonen, J