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0499 - INCIDENCE AND PROGNOSTIC SIGNIFICANCE OF HYPERGLYCEMIA IN ACUTE PERIOD OF ANTERIOR PART CIRCLE OF WILLIS CEREBRAL ANEURYSM RUPTURE
J.V. Titova1, E.A. Karapetyan1, A.A. Solodov1, S.S. Petrikov1, V.V. Krylov1
1Medical Emergency Scientific Research Institute n.a.N.V. Sklifosovsky, Moscow, Russian Federation
Paris 2013
Abstract
INTRODUCTION. Hyperglycemia (HG) is a risk factor of poor-grade outcome in patients (pts) with subarachnoid hemorrhage (SAH) due to cerebral aneurysm rupture. But the incidence of HG in pts with SAH is not defined.
OBJECTIVES. To determine the incidence and prognostic significance of HG in acute period of anterior part circle of Willis cerebral aneurysm rupture.
METHODS. Medical reports retrospective analysis of 165 pts (age 48.9±11; male/female - 75/90) with SAH due to anterior circle of Willis aneurysm rupture was presented. Diabetes mellitus was exclusion criteria. Hunt and Hess (H-H) scale severity grading was: II-in 26.1% pts, III-in 59.4% pts, IV-in 12.1% pts and V-in 2.4% pts. Fisher SAH computed tomography (CT) grading scale was: 1-in 10.9% pts, 2-in 1.2% pts, 3-in 21.2% pts, 4-in 66.7% pts. The localization of aneurysm ruptured was: middle cerebral artery (MCA)-in 24.2% pts, anterior cerebral artery-anterior communicating artery (ACA-ACoA)-in 52.7% pts and internal carotid artery (ICA)-in 23.1% pts. Aneurysm surgical clipping or endovascular coiling was performed in all pts in acute period of SAH. Cerebral vasospasm was revealed in 64 pts (38,7%) in early postoperative period by transcranial dopplerography (cerebral blood flow velocity in involved MCA 120 cm/sec and higher and Lindegaard index 3 and more). All pts (n=165) were divided in 4 groups (GR) on the base of severity and CT scale grading: GR 1-H-H II, Fisher 3-4 (n=43), GR 2-H-H III-IV, Fisher 1-2 (n=19), GR 3-H-H III-IV, Fisher 3-4 (n=99), GR 4-H-H V, Fisher 1-4 (n=4). Blood glucose concentration (BGC) was determined and compared in GR 1 - 4 during 24 hours after surgery. HG was defined as the increase of BGC up to 6.1 mmol/l and more. ABL 800 analyzer was used for BGC measurement 1-4 times per 24 hours (334 samples totally). We analyzed maximal during 24 hours BGC in SAH pts.
RESULTS. HG (6.1-10 mmol/l) was revealed in 51% pts, severe HG more than 10 mmol/l - in 37% pts, normoglycemia - just in 12% pts. Comparison of HG incidence in pts with different aneurysm localization, grade of H-H severity and Fisher scale is presented in table 1.

  Normoglycemia (less than 6.1 mmol/l), % HG (6.1 mmol/l and more), % HG (6.1-10 mmol/l), % HG (more than 10 mmol/l), %
MCA 12.2 87.8 48.8 39
ACA-ACoA 9.1 90.9 50 40.9
ICA 18.4 81.6 55.3 26.3
GR 1 (H-H II, Fisher 3-4), n=43 13.9 86.1 60.5 25.6
GR 2 (H-H III-IV, Fisher 1-2), n=19 10.5 89.5 47.4 42.1
GR 3 (H-H III-IV, Fisher 3-4), n=99 12.1 87.9 48.5 39.4
GR 4 (H-H V, Fisher 1-4), n=4 0 100 25 75
[Table 1. Hyperglycemia incidence]


Clinical outcome at BGC different levels in acute period of anterior part circle of Willis cerebral aneurysm rupture is presented in table 2.

  Normoglycemia (less than 6.1 mmol/l) HG (6.1-10 mmol/l) HG (more than 10 mmol/l)
Mortality rate, % 15 20.2 31.1
High grade outcome (Glasgow outcome scale 4-5), % 80 73.9 65.6
[Table 2. Clinical outcome]


CONCLUSIONS. Hyperglycemia incidence in pts with anterior part circle of Willis cerebral aneurysm rupture in first day after surgery is 88%. Incidence and level of hyperglycemia does not depend on aneurysm localization and increases at grade of severity H-H III and higher and Fisher CT scale 3-4. Hyperglycemia in the first day after neurosurgical procedure is accompanied by increase of mortality rate and decrease of high-grade outcome.
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