Sayantani Ghosh , Saugat Dey , Mitchell Maltenfort , Mathew Vibbert , Jack Jallo
Introduction: There has been considerable controversy regarding the effect of serum and cerebrospinal fluid (csf) glucose levels in the prognosis of aneurysmal subarachnoid hemorrhage (aSAH) patients.
Objective: We have explored the relationship between serum and csf glucose serum glucose levels in such patients and have also explored the levels of serum and csf glucose required to maintain a good outcome.
Methods: Retrospective review of 2000 aSAH patients, from a prospectively collected database of Thomas Jefferson University Hospital, was done. The Hunt-Hess (H-H) grade of the SAH, cerebral and serum glucose on admission, serum glucose on the day of surgery and 14 days post the surgery as well as the GOS-E score at discharge was noted. Parameters were analyzed individually for significance via contingency tables and significant parameters (p < 0.05) were further examined. Relationship between serum and csf glucose is established via Spearman's rank correlation coefficient.
Result: Correlation between csf and serum glucose at admission was found to be 0.52, it increased from HH grade 1-4 and then became negative but more tightly bound at HH5. Serum glucose higher than 151.58 mg/dl (95% confidence interval, 141.36- 160.63) and csf glucose higher than 77.83 mg/dl (95% confidence interval, 75.05- 80.61) was found to be associated with worse outcome. 95.57% of the patients, who had even a single event of hypoglycemia, have had a previous episode of hyperglycemia and fared badly. Csf glucose < 38 mg/dl also led to more deaths.
Conclusion: Serum and csf glucose bear a linear relationship in mild to moderate SAH. Incidences of hypoglycemia in aSAH patients are mainly due to the intensive insulin therapy to combat a hyperglycemic episode and results in worse outcome. Hence, serum glucose level of 80-140 mg/dl and csf glucose level of 38-75 mg/dl should be maintained in all aSAH patients.
