血糖控制对动脉瘤性蛛网膜下腔出血后预后的影响：应激性高血糖和慢性血糖状态的综合分析

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-09-03 DOI:10.1016/j.jocn.2025.111604

Sapna Suresh , Ajay Prasad Hrishi , Karen Ruby Lionel , Sravan Sreekumar , Parvathy Dinesh

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引用次数: 0

摘要

背景eurysmal蛛网膜下腔出血（aSAH）经常诱发应激性高血糖，但基线血糖控制与临床结果之间的关系尚不清楚。本研究探讨了糖化血红蛋白（HbA1c）水平与aSAH患者临床结局之间的关系，特别关注应激性高血糖（SIH）模式。方法本前瞻性观察性研究纳入155例年龄≥18岁的连续aSAH患者。患者根据入院HbA1c水平进行分层（< 6.0% vs≥6.0%）。在HbA1c值小于6.0%的患者中。e，无糖尿病史)，计算应激性高血糖比（SHR），并进一步分为低SHR （<1.14）和高SHR （>1.14）两组。主要结局包括迟发性脑缺血（DCI）和3个月时的功能结局。次要结局包括院内并发症、住院时间和死亡率。结果155例患者（平均年龄55.4±13.2岁）中，116例（74.8%）HbA1c≥6.0%，39例（25.2%）HbA1c≥6.0%。HbA1c升高的患者DCI发生率显著升高（46.2% vs 24.1%, p = 0.011）， ICU住院时间延长（12.4±8.7 vs 8.2±6.4天，p = 0.002），功能预后较差（53.8% vs 32.8%, mRS 3-6, p = 0.026）。HbA1c水平正常的患者更常发生SIH，并且与基线血糖控制无关的不良结局相关。HbA1c水平升高可作为aSAH患者预后不良的独立预测因子。在基线血糖控制正常的SIH患者中，不良结局显著相关，包括DCI率增加（31.9% vs 11.4%, p = 0.021）和住院时间延长。结论HbA1c升高的患者迟发性脑缺血（DCI）发生率显著增高，ICU住院时间延长，功能预后不良。在基线血糖控制正常的患者中，与SHR正常的患者相比，高应激性高血糖比（SHR）为1.14的患者发生DCI的几率高出3.6倍。

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Effect of glycemic control on outcomes after aneurysmal subarachnoid hemorrhage: A comprehensive analysis of stress-induced hyperglycemia and chronic glycemic status

Background

Aneurysmal subarachnoid hemorrhage (aSAH) frequently precipitates stress-induced hyperglycemia, yet the relationship between baseline glycemic control and clinical outcomes remains poorly understood. This study investigates the association between glycosylated hemoglobin (HbA1c) levels and clinical outcomes in aSAH patients, with a particular focus on stress-induced hyperglycemia(SIH) patterns.

Methods

This prospective observational study enrolled 155 consecutive aSAH patients aged ≥ 18 years. Patients were stratified based on admission HbA1c levels (<6.0 % vs ≥ 6.0 %). Among patients with HbA1c values less than 6.0 %(i.e, without history of diabetes), stress hyperglycemia ratio (SHR)was calculated and further categorized into patients with low SHR (<1.14) and high SHR (>1.14). Primary outcomes included delayed cerebral ischemia (DCI) and functional outcomes at 3 months. Secondary outcomes encompassed in-hospital complications, length of stay, and mortality.

Results

Among 155 patients (mean age 55.4 ± 13.2 years), 116 (74.8 %) had HbA1c < 6.0 % and 39 (25.2 %) had HbA1c ≥ 6.0 %. Patients with elevated HbA1c demonstrated significantly higher rates of DCI (46.2 % vs 24.1 %, p = 0.011), prolonged ICU stay (12.4 ± 8.7 vs 8.2 ± 6.4 days, p = 0.002), and poor functional outcomes (53.8 % vs 32.8 % with mRS 3–6, p = 0.026). SIH occurred more frequently in patients with normal HbA1c levels, and was associated with adverse outcomes independent of baseline glycemic control. Elevated HbA1c levels serve as an independent predictor of poor outcomes in aSAH patients. Among patients with normal baseline glycemic control who developed SIH, there was a significant association with adverse outcomes, including increased DCI rates (31.9 % vs 11.4 % in those without stress hyperglycemia, p = 0.021) and prolonged hospital stays.

Conclusions

Patients with elevated HbA1c demonstrated significantly higher rates of delayed cerebral ischemia (DCI), prolonged ICU stay, and poor functional outcomes. A high stress hyperglycemia ratio (SHR) > 1.14 is associated with 3.6 times greater odds of developing DCI when compared to patients having a normal SHR in patients with normal baseline glycemic control.

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.