Initial 24-Hour ICU Glucose Levels are Associated with the Development of Cerebral Vasospasm after Subarachnoid Haemorrhage

Cerebral vasospasm (CVS) is a well-known cause of morbidity and mortality amongst patients who have suffered from subarachnoid haemorrhage (SAH). Its presence is associated with reduced cerebral perfusion and potential further development of neurological deficit. The aetiology of CVS has been proven...

Ausführliche Beschreibung

Gespeichert in:
1. Verfasser: Breiding, Philipe Sebastian
Beteiligte: Geldner, Götz (Prof. Dr. med.) (BetreuerIn (Doktorarbeit))
Format: Dissertation
Sprache:Englisch
Veröffentlicht: Philipps-Universität Marburg 2017
Klinik für Anästhesie und Intensivtherapie
Schlagworte:
SAB
CVS
SAH
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Zusammenfassung:Cerebral vasospasm (CVS) is a well-known cause of morbidity and mortality amongst patients who have suffered from subarachnoid haemorrhage (SAH). Its presence is associated with reduced cerebral perfusion and potential further development of neurological deficit. The aetiology of CVS has been proven to be multifactorial and several risk factors have been associated with its development. Since CVS has been linked to signalling changes in vascular endothelium, serum glucose was chosen as a potential prognostic indicator and risk factor due to its relation with endothelial dysfunction. The objective of this study was to evaluate the association between serum glucose levels in ICU patients admitted with SAH and the development of CVS. The study is a retrospective observational study in which data was collected on patients admitted to the ICU of Pauls Stradiņš Clinical University Hospital with the primary diagnosis of SAH. We compared serum glucose levels on ICU admission and average glucose levels for the first 5 days in the ICU in patients with and without subsequent development of CVS. Twenty-four patients diagnosed with SAH were included in the study. CVS was confirmed in 25% (n=6). There was no significant difference in age and gender distribution between groups. Patients with subsequent development of CVS had higher WFNS score values (4.80 and 3.56; p=0.008). We found lower mean glucose levels on admission for patients that developed CVS compared to those that did not develop CVS (7.32 and 9.28 mmol/L; p=0.05). The average glucose levels on first 24h of ICU stay were also lower in patients who developed CVS (7.26 and 9.29 mmol/L; p=0.03). There were no significant differences in average glucose levels between groups from day 2 to day 5 of ICU stay. Overall mortality was not affected by ICU glucose levels and average glucose levels of first 24h were negatively correlated to the duration of ICU stay (rs = -0.408, p<0.05). The study shows that admission and initial average 24h glucose levels may prove to be a prognostic indicator for the potential development of CVS after SAH. Glucose averages of the first day of ICU stay were significantly related to the development of CVS and may demonstrate importance after further investigation, possibly with a larger patient group.
Beschreibung:41 pages.
DOI:http://dx.doi.org/10.17192/z2017.0796