VPS dependency after aneurysmal subarachnoid haemorrhage and influence of admission hyperglycaemia.

Hostettler, Isabel Charlotte; Lange, Nicole; Schwendinger, Nina; Ambler, Gareth; Hirle, Theresa; Frangoulis, Samira; Trost, Dominik; Gempt, Jens; Kreiser, Kornelia; Meyer, Bernhard; Winter, Christof; Wostrack, Maria

doi:10.1177/23969873221147087

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Title:: VPS dependency after aneurysmal subarachnoid haemorrhage and influence of admission hyperglycaemia.
Document type:: Journal Article
Author(s):: Hostettler, Isabel Charlotte; Lange, Nicole; Schwendinger, Nina; Ambler, Gareth; Hirle, Theresa; Frangoulis, Samira; Trost, Dominik; Gempt, Jens; Kreiser, Kornelia; Meyer, Bernhard; Winter, Christof; Wostrack, Maria
Abstract:: INTRODUCTION: Hydrocephalus after aneurysmal subarachnoid haemorrhage (aSAH) is a common complication which may lead to insertion of a ventriculoperitoneal shunt (VPS). Our aim is to evaluate a possible influence of specific clinical and biochemical factors on VPS dependency with special emphasis on hyperglycaemia on admission. PATIENTS AND METHODS: Retrospective analysis of a monocentric database of aSAH patients. Using univariable and multivariable logistic regression analysis we evaluated factors influencing VPS dependency, with a special focus on hyperglycaemia on blood sample within 24 h of admission, dichotomised at 126 mg/dl. Factors evaluated in the univariable analysis were age, sex, known diabetes, Hunt and Hess grade, Barrow Neurological Institute scale, treatment modality, extra-ventricular drain (EVD) insertion, complications (rebleeding, vasospasm, infarction, decompressive craniectomy, ventriculitis), outcome variables and laboratory parameters (glucose, C-reactive protein, procalcitonin). RESULTS: We included 510 consecutive patients treated with acute aSAH requiring a VPS (mean age 58.2 years, 66% were female). An EVD was inserted in 387 (75.9%) patients. In the univariable analysis, VPS dependency was associated with hyperglycaemia on admission (OR 2.56, 95%CI 1.58-4.14, p < 0.001). In the multivariable regression analysis after stepwise backward regression, factors associated with VPS dependency were hyperglycaemia >126 mg/dl on admission (OR 1.93, 95%CI 1.13-3.30, p = 0.02), ventriculitis (OR 2.33, 95%CI 1.33-4.04, p = 0.003), Hunt and Hess grade (overall p-value 0.02) and decompressive craniectomy (OR 2.68, 95%CI 1.55-4.64, p < 0.001). CONCLUSION: Hyperglycaemia on admission was associated with an increased probability of VPS placement. If confirmed, this finding might facilitate treatment of these patients by accelerating insertion of a permanent draining system.
Journal title abbreviation:: EUROPEAN STROKE JOURNAL
Year:: 2023
Journal volume:: 8
Journal issue:: 1
Pages contribution:: 301-308
Fulltext / DOI:: doi:10.1177/23969873221147087
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/37021154
Print-ISSN:: 2396-9873
TUM Institution:: Institut für Klinische Chemie und Pathobiochemie (Prof. Ruland); Klinik und Poliklinik für Neurochirurgie (Prof. Meyer)
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