Initial hyperglycemia as an indicator of severity of the ictus in poor-grade patients with spontaneous subarachnoid hemorrhage

An association between hyperglycemia and outcome in spontaneous subarachnoi d hemorrhage (SAH) has been sporadically reported. Our hypothesis was that hyperglycemia is a sign of central metabolic disturbance linked with specif ic appearances on computerized tomography (CT) scans reflecting different d egrees of corresponding brain injury. The admission plasma glucose level. i nitial 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 quant itatively assessed for subarachnoid blood, intracerebral hematoma, intraven tricular hemorrhage, hydrocephalus, midline shift and compression of the pe rimesencephalic cisterns. These findings were combined to determine a three -point CT severity score. All patients showed elevated (> 5.8 mmol/l) plasm a glucose levels on admission. Mortality among 33 patients with glucose con centration below 9.0 mmol/l was 33.3%, 71.1% for the 45 patients with gluco se level between 9.0 and 13.0 mmol/l, and 95.2% for the 21 patients with co ncentration above 13.0 mmol/l (P < 0.0001). Glucose level was higher in Gra de V than in Grade IV patients (mean +/- SD) (11.5 +/- 3.2 vs 9.8 +/- 2.9 m mol/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 sever e 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, logis tic multiple regression revealed the admission plasma glucose level to be a n independent prognosticator of outcome. The prognostic potential of the in itial plasma glucose level may be beneficial in management protocols of poo r-grade SAH patients. (C) 2000 Elsevier Science B.V. All rights reserved.