VPS dependency after aneurysmal subarachnoid haemorrhage and influence of admission hyperglycaemia

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

doi:10.1177/23969873221147087

VPS dependency after aneurysmal subarachnoid haemorrhage and influence of admission hyperglycaemia

Eur Stroke J. 2023 Mar;8(1):301-308. doi: 10.1177/23969873221147087. Epub 2022 Dec 28.

Authors

Affiliations

¹ Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
² Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
³ Department of Statistical Science, University College London, London, UK.
⁴ Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
⁵ Institute of Clinical Chemistry and Pathobiochemistry, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.

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.

Keywords: Aneurysmal subarachnoid haemorrhage; VPS dependency; hydrocephalus; hyperglycaemia; risk factors.

MeSH terms

Cerebral Ventriculitis* / complications
Female
Gastritis* / complications
Humans
Hyperglycemia* / complications
Male
Middle Aged
Retrospective Studies
Subarachnoid Hemorrhage* / complications
Ventriculoperitoneal Shunt / adverse effects