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| Prognostic value of blood glucose fluctuations in patients with aneurismal subarachnoid haemorrhage admitted to Intensive Care Unit |
| Zhang A-fang, Yao Li, Zhang Hong |
| Department of Emergency, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China |
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Abstract Objective Our study was to explore the clinical prognosis value of blood glucose fluctuations in aneurismal subarachnoid haemorrhage (aSAH) patients admission to Intensive Care Unit (ICU). Methods This prospective observational study included 65 consecutive patients with aSAH in the ICU of our hospital. All the patients were continuously monitored by glucose monitoring system (CGMS) for 72 hours, while the value of lactate at admission was detected and the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) scores within 24 hours among these patients were investigated. The mean blood glucose value (MBG), standard deviation of blood glucose (SDBG), mean amplitude of glycemic excursions (MAGE), the largest amplitude of glycemic excursions (LAGE) and mean of daily differences (MODD) were compared between the two groups. End point of this study was 28-day mortality rate. Clinical data including blood lactate at admission and APACHEⅡ scores within 24 h in survivors and non-survivors respectively. Results The MBG, SDBG, LAGE, MAGE, MODD were statistically significantly higher in patients died of aSAH than in patients survived aSAH (all P<0.05). Using receiver operating curve (ROC) analysis, the best cut-off values of MAGE and APACHEⅡ scores at 24 h later for predicting 28-day mortality were 3.685 mmol/L (sensitivity 85.2%, specificity 63.2%) and 21.5 (sensitivity 77.8%, specificity 71.1%), based on the calculated areas under the curve (AUCs) of 0.807 (95%CI, 0.700 to 0.914), 0.819 (95%CI, 0.706to 0.931), respectively. In Logistic regression analysis, both MAGE and APACHEⅡ scores at 24 h later were independently associated with 28-day mortality (P<0.05). Conclusion The level of MAGE was significantly higher in patients died of aSAH in ICU than patients survived and the predictive power was higher than the value of APACHEⅡ scores at 24 h post-admission.
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Corresponding Authors:
Zhang Hong, E-mail:zhanghong20070703@163.com
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| ［1］Elijovich L，Higashida RT，Lawton MT，et a1．Predictors and outcomes of intraprocedura1 rupture in patients treated for ruptured intracranial aneurysms：the CARAT study［J］．Stroke， 2008， 39(5)：1501-1506．
［2］Lazaridis C，Naval N．Risk factors and medical management of vasospasm after subarachnoid hemorrhage［J］．Neurosurg Clin N Am， 2010， 21（2）：353-364.
［3］徐杨，周健，姚海军. 颅脑创伤早期动态监测血糖对判断预后的作用［J］.中华急诊医学杂志, 2009， 18(5):516-518.
［4］马艳霞, 吕肖锋，焦秀敏，等. 2型糖尿病合并急性脑梗死患者血糖波动与溶栓预后的关系［J］.中国脑血管病杂志， 2014， 11(8):415-419.
［5］刘萍萍，胥志跃，卢秀兰，等. 重症患儿血糖监测与危重度关系的研究［J］. 中华急诊医学杂志, 2012, 21(5):478-483.
［6］Chan MC, Tseng JS, Hsu KH, et a1. A minimum blood glucose value less than or equal to 120 mg/dL under glycemic control is associated with increased 14-day mortality in nondiabetic intensive care unit patients with sepsis and stress hyperglycemia［J］. J Crit Care, 2016, 34:69 -73．
［7］Van Donkelaar CE, Dijkland SA，van den Bergh WM, et a1． Early circulating lactate and glucose levels after aneurysmal subarachnoid hemorrhage correlate with poor outcome and delayed cerebral ischemia ： a two center cohort study ［J］．Crit Care Med, 2016, 44（5）：966-972．
［8］Bederson JB，Connolly ES Jr，Batjer HH，et a1．Guidelines for the management of aneurysmal subarachnoid hemorrhage：a statement for healthcare professionals from a special writing group of the Stroke Council，American Heart Association ［J］. Stroke, 2009, 40(3)：994-1025．
［9］Monnier L, Mas E, Ginet C, et al. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes［J］. JAMA, 2006, 295(14): 1681-1687.〖ZK)〗
［10］Wang JS, Yin HJ, Guo CY, et al. Influence of high blood glucose fluctuation on endothelial function of type 2 diabetes mellitus rats and effects of Panax Quinquefolius Saponin of stem and leaf［J］. Chin J Integr Med, 2013, 19(3): 217-222.
［11］Naber CK, Mehta RH, Jünger C, et al. Impact of admission blood glucose on outcome of nondiabetic patients with acute ST-elevation myocardial infarction (from the German Acute Coronary Syndromes ［ACOS］ Registry)［J］. Am J Cardiol, 2009, 103（5）:583-587.
［12］Claassen J, Vu A，Kreiter KT，et a1．Effect of acute physiologic derangements on outcome after subarachnoid hemorrhage［J］. Crit Care Med, 2004, 32(3)：832-838． |
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