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VPS dependency after aneurysmal subarachnoid haemorrhage and influence of admission hyperglycaemia

Hostettler, IC; Lange, N; Schwendinger, N; Ambler, G; Hirle, T; Frangoulis, S; Trost, D; ... Wostrack, M; + view all (2022) VPS dependency after aneurysmal subarachnoid haemorrhage and influence of admission hyperglycaemia. European Stroke Journal 10.1177/23969873221147087. (In press). Green open access

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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.

Type: Article
Title: VPS dependency after aneurysmal subarachnoid haemorrhage and influence of admission hyperglycaemia
Open access status: An open access version is available from UCL Discovery
DOI: 10.1177/23969873221147087
Publisher version: https://doi.org/10.1177/23969873221147087
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Science & Technology, Life Sciences & Biomedicine, Clinical Neurology, Peripheral Vascular Disease, Neurosciences & Neurology, Cardiovascular System & Cardiology, Aneurysmal subarachnoid haemorrhage, hydrocephalus, hyperglycaemia, VPS dependency, risk factors, DELAYED CEREBRAL-ISCHEMIA, INTRACRANIAL ANEURYSMS, RISK-FACTORS, CEREBROSPINAL-FLUID, HYDROCEPHALUS, HYPERTENSION, VASOSPASM, RUPTURE
UCL classification: UCL
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Maths and Physical Sciences
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Maths and Physical Sciences > Dept of Statistical Science
URI: https://discovery.ucl.ac.uk/id/eprint/10164324
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