PLASMA-GLUCOSE LEVELS AND OUTCOME AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE

Plasma glucose levels were studied in 616 patients admitted within 72 hours after subarachnoid hemorrhage (SAH). Glucose levels measured at admission showed a statistically significant association with Glasgow Coma Scale scores, Botterell grade, deposition of blood on computerize d tomography (CT) scans, and level of consciousness at admission. Elev ated glucose levels at admission predicted poor outcome. A good recove ry, as assessed by the Glasgow Outcome Scale at 3 months, occurred in 70.2% of patients with normal glucose levels (less-than-or-equal-to 12 0 mg/dl) and in 53.7% of patients with hyperglycemia (> 120 mg/dl) (p = 0.002). The death rates for these two groups were 6.7% and 19.9%, re spectively (p = 0.001). The association was still maintained after adj usting for age (> or less-than-or-equal-to 50 years) and thickness of clot on CT scans (thin or thick) in the subset of patients who were al ert/drowsy at admission. Increased mean glucose levels between Days 3 and 7 also predicted a worse outcome; good recovery was observed in 13 2 (73.7%) of 179 patients who had normal mean glucose levels (less-tha n-or-equal-to 120 mg/dl) and 160 (49.7%) of 322 who had elevated mean glucose levels (> 120 mg/dl) (p < 0.0001). Death occurred in 6.7% and 20.8% of the two groups, respectively (p < 0.0001). It is concluded th at admission plasma glucose levels can serve as an objective prognosti c indicator after SAH. Elevated glucose levels during the 1st week aft er SAH also predict a poor outcome. However, a causal link between hyp erglycemia and outcome after delayed cerebral ischemia, although sugge sted by experimental data, cannot be established on the basis of this study.