The Influence of Hyperglycemia at Acute Phase of Aneurysmal Subarachnoid Hemorrhage on One-year Mortality

doi:10.3969/j.issn.1673-5765.2016.11.007

Abstract

Abstract:

Objective To investigate the glucose level at acute phase of aneurysmal subarachnoid hemorrhage (aSAH) on long-term outcome of patients. Methods Patients who were diagnosed as aSAH without history of diabetes and admitted within 3 h after onset by Beijing Tiantan Hospital, Capital Medical University were enrolled to assess fasting glucose on admission, day 14 and their variation. Multivariate Cox regression analysis was used to assess risk factors for 1-year mortality. Results A total of 239 aSAH patients without history of diabetes were enrolled and followed up in this study. Admission glucose levels were found to be positively associated with 1-year mortality (hazard ratio [HR] 1.415, 95% confidence interval [CI ] 1.166-1.718). Within 14 days after onset of disease, there were 85 cases of patients had increased blood glucose level compared with that of on admission and there were 146 cases of patients had decreased or unchanged level of blood glucose compared with that of on admission. The blood glucose increased group had obviously increased mortality rate compared with the decreased and unchanged group (61.54% vs 33.66%, P =0.006). In addition, higher blood glucose levels were also associated with an elevated 1-year mortality (HR 1.317, 95%CI 1.132-1.532). Conclusion Fasting glucose levels at admission and their variation within 14 d after aSAH are predictive factors of an elevated 1-year mortality rate.

Key words: Hyperglycemia; Subarachnoid hemorrhage; Aneurysmal; Outcomes; Mortality

摘要：

目的探讨动脉瘤性蛛网膜下腔出血急性期血糖水平对患者长期预后的影响。方法连续入组首都医科大学附属北京天坛医院收治的发病时间在3 d内、无糖尿病病史的动脉瘤性蛛网膜下腔出血患者，分析患者入院、发病14 d空腹血糖以及血糖变化趋势。多因素Cox生存比例回归分析用以评价影响发病1年全因死亡的因素。结果 239例无糖尿病病史的动脉瘤性蛛网膜下腔出血患者进入研究并最终完成全部随访。结果显示入院时空腹血糖越高的患者，1年死亡率越高[危险比（hazard ratio，HR）1.415，95%可信区间（confidence interval，CI ），1.166～1.718]。发病14 d时有85例（36.80%）患者血糖较入院时增高，146例患者血糖较入院时降低或不变，死亡患者中血糖升高比例显著高于存活患者中血糖升高的比例（61.54% vs 33.66%，P =0.006）。Cox生存比例回归分析显示发病14 d血糖升高（HR 1.317， 95%CI 1.132～1.532），患者1年死亡风险越大。结论入院时空腹血糖以及发病14 d内血糖的变化是不伴糖尿病的动脉瘤性蛛网膜下腔出血患者1 年死亡的独立预测因素。

关键词: 高血糖; 颅内动脉瘤; 蛛网膜下腔出血; 预后; 死亡

HOU Zong-Gang, TAO Xiao-Gang, TIAN Run-Fa, et al.. The Influence of Hyperglycemia at Acute Phase of Aneurysmal Subarachnoid Hemorrhage on One-year Mortality[J]. Chinese Journal of Stroke, 2016, 11(11): 934-941.

侯宗刚，陶晓刚，田润发，边立衡. 动脉瘤性蛛网膜下腔出血急性期高血糖对患者一年死亡的影响[J]. 中国卒中杂志, 2016, 11(11): 934-941.

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