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  • Stress Induced Hyperglycemia Determines External Ventricular Drain Placement in Non-Hydrocephalic Aneurysmal Subarachnoid Hemorrhage - A Retrospective Single Center Study

    Final Number:

    Bappaditya Ray MD; Ayumi Ludwig MD; Lori K Yearout BS; David M Thompson; Bradley N. Bohnstedt MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Stress-induced hyperglycemia (SIH) may occur after acute brain injuries like acute ischemic stroke, traumatic brain injury, intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage (aSAH). Patients who experience SIH are at heightened risk of deleterious effects like cerebral edema. SIH among aSAH patients has not been evaluated systematically. This study examines if SIH has an association of external ventricular device (EVD) placement among non-hydrocephalic aSAH patients

    Methods: A cohort of 194 patients who were admitted within three days of experiencing aSAH. Hydrocephalus (HCP) was defined by age adjusted bicaudate index (BCI). SIH was defined by admission glucose (AG) to glycated hemoglobin (HbA1c) ratio and glycemic gap (GG = AG - 28.7*HbA1c + 46.7). We performed ROC analysis to assess the ratio’s and GG’s utility in identifying patients who would require EVD at admission

    Results: Age of the entire cohort was 52.8±13.4 years with 65% of the patients being women. Forty-eight patients had HCP at admission with 40 (83.3%) needing EVD whereas only 82 (56.2%) of 146 non-hydrocephalic patients required EVD. A AG:HbA1c ratio threshold value of 28 and GG of 45 mg/dl afforded a specificity of 0.81 and 0.84 respectively to identify those requiring EVD among non-hydrocephalic patients due to SIH. EVD was placed in 36/47 (76.6%) of those with ratios >28, and in 46/99 (46.5%) of those with lower ratios (p=0.0006). The area under the ROC curve for the AG:HbA1c ratio was 0.67 (95% CI: 0.57-0.74). Similarly, for GG the area under the ROC curve was 0.65 (95% CI: 0.56-0.74). Moreover, patients who had severe SIH as defined by AG:HbA1c >28 had EVD placed more often than normoglycemic (defined as ratio <20) aSAH patients [36/47 (76.6%) vs. 12/31 (38.7%), p=0.0008]

    Conclusions: These results establish an association between SIH following aSAH and EVD placement in non-hydrocephalic aSAH

    Patient Care: This study will provide data and basis for prospective study to investigate the role of acute hyperglycemia after aneurysmal subarachnoid hemorrhage and how appropriate management of this metabolic derangement would lead to better patient outcome.

    Learning Objectives: 1. State the occurence of stress induced hyperglycemia after aneurysmal subarachnoid hemorrhage 2. Determine the need for external ventricular device placement after in stress induced hyperglycemia after aneurysmal subarachnoid hemorrhage


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