Glycemic indices predict outcomes after aneurysmal subarachnoid hemorrhage: a retrospective single center comparative analysis

Abstract

Although hyperglycemia is associated with worse outcomes after aneurysmal subarachnoid hemorrhage (aSAH), there is no consensus on the optimal glucose control metric, acceptable in-hospital glucose ranges, or suitable insulin regimens in this population. In this single-center retrospective cohort study of aSAH patients, admission glucose, and hospital glucose mean (MHG), minimum (MinG), maximum (MaxG), and variability were compared. Primary endpoints (mortality, complications, and vasospasm) were assessed using multivariate logistic regressions. Of the 217 patients included, complications occurred in 83 (38.2%), 124 (57.1%) had vasospasm, and 41 (18.9%) died. MHG was independently associated with (p < 0.001) mortality, MaxG (p = 0.017) with complications, and lower MinG (p = 0.015) with vasospasm. Patients with MHG ≥ 140 mg/dL had 10 × increased odds of death [odds ratio (OR) = 10.3; 95% CI 4.6-21.5; p < 0.0001] while those with MinG ≤ 90 mg/dL had nearly 2× increased odds of vasospasm (OR = 1.8; 95% CI 1.01-3.21; p = 0.0422). While inpatient insulin was associated with increased complications and provided no mortality benefit, among those with MHG ≥ 140 mg/dL insulin therapy resulted in lower mortality (OR = 0.3; 95% CI 0.1-0.9; p = 0.0358), but no increased complication risk. While elevated MHG and MaxG are highly associated with poorer outcomes after aSAH, lower MinG is associated with increased vasospasm risk. Future trials should consider initiating insulin therapy based on MHG rather than other hyperglycemia measures.

Figure 1

The effect of aneurysmal subarachnoid hemorrhage severity on mean admission day glucose (left) and mean hospital glucose (right). Asterisks indicate post-hoc significance among groups. **p < 0.01, ***p < 0.001, ****p < 0.0001.

Figure 2

Risk of mortality (left), complications (middle), and vasospasm (right) versus glycemic variables that were significant in multivariate analysis. Each glycemic variable was binned into ordinal groups, and only groups with ≥ 2 members are shown. Simple linear regressions are shown.

Figure 3

Receiver operating characteristic (ROC) curves for predicting in-hospital mortality (left), complications (middle), and vasospasm (right). Variables with corresponding area under the curve (AUC) are shown for the two glycemic variables with the highest significance. HH (left, middle) or Fisher score (right) are plotted for comparison.