Patients with elevated blood glucose levels at the time of cerebral aneurysm clipping are at increased risk for impaired cognition and possibly deficits in gross neurologic function at 3-month follow-up, new research shows.
As reported in the April issue of the Mayo Clinic Proceedings, Dr. Jeffrey J. Pasternak, from the Mayo Clinic in Rochester, Minnesota, and colleagues analyzed data from 1000 patients who participated in the Intraoperative Hypothermia for Aneurysm Trial. The subjects, who were recruited between February 2000 and April 2003, underwent aneurysm clipping within 14 days of a subarachnoid hemorrhage.
Blood glucose levels at the time of clipping ranged from 59 to 331 mg/dL, the report indicates.
A glucose level of 129 mg/dL or more was predictive of impaired cognition at 3 months (p = 0.03), the authors note. With levels above 152 mg/dL, the risk of gross neurologic dysfunction, as determined with the National Institutes of Health Stroke Scale, increased as well (p < 0.05).
Patients with glucose levels of 129 mg/dL or more also had longer intensive care unit stays than patients with lower levels, but comparable total hospital stays and likelihood of home discharge.
"More research is needed to determine whether the association we identified represents cause and effect and to establish the critical timing of hyperglycemia," the authors state. "Until such research is completed, we contend that our findings-when taken in the context of an extensive body of related research-argue in favor of rigid glucose control in patients with aneurysmal subarachnoid hemorrhage who undergo aneurysm clipping surgery."
Mayo Clin Proc 2008;83:406-417.
Reviewed By Ramaz Mitaishvili, MD
