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

Autor:	Hostettler IC; Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.; Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland., Lange N; Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany., Schwendinger N; Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany., Ambler G; Department of Statistical Science, University College London, London, UK., Hirle T; Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany., Frangoulis S; Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany., Trost D; Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany., Gempt J; Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany., Kreiser K; Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany., Meyer B; Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany., Winter C; Institute of Clinical Chemistry and Pathobiochemistry, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany., Wostrack M; Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Jazyk:	angličtina
Zdroj:	European stroke journal [Eur Stroke J] 2023 Mar; Vol. 8 (1), pp. 301-308. Date of Electronic Publication: 2022 Dec 28.
DOI:	10.1177/23969873221147087
Abstrakt:	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. Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. (© European Stroke Organisation 2022.)
Databáze:	MEDLINE
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