Effect of glycemic control on outcomes after aneurysmal subarachnoid hemorrhage: A comprehensive analysis of stress-induced hyperglycemia and chronic glycemic status.

Background: Aneurysmal subarachnoid hemorrhage (aSAH) frequently precipitates stress-induced hyperglycemia, yet the relationship between baseline glycemic control and clinical outcomes remains poorly understood. This study investigates the association between glycosylated hemoglobin (HbA1c) levels and clinical outcomes in aSAH patients, with a particular focus on stress-induced hyperglycemia(SIH) patterns.

Methods: This prospective observational study enrolled 155 consecutive aSAH patients aged ≥ 18 years. Patients were stratified based on admission HbA1c levels (<6.0 % vs ≥ 6.0 %). Among patients with HbA1c values less than 6.0 %(i.e, without history of diabetes), stress hyperglycemia ratio (SHR)was calculated and further categorized into patients with low SHR (<1.14) and high SHR (>1.14). Primary outcomes included delayed cerebral ischemia (DCI) and functional outcomes at 3 months. Secondary outcomes encompassed in-hospital complications, length of stay, and mortality.

Results: Among 155 patients (mean age 55.4 ± 13.2 years), 116 (74.8 %) had HbA1c < 6.0 % and 39 (25.2 %) had HbA1c ≥ 6.0 %. Patients with elevated HbA1c demonstrated significantly higher rates of DCI (46.2 % vs 24.1 %, p = 0.011), prolonged ICU stay (12.4 ± 8.7 vs 8.2 ± 6.4 days, p = 0.002), and poor functional outcomes (53.8 % vs 32.8 % with mRS 3-6, p = 0.026). SIH occurred more frequently in patients with normal HbA1c levels, and was associated with adverse outcomes independent of baseline glycemic control. Elevated HbA1c levels serve as an independent predictor of poor outcomes in aSAH patients. Among patients with normal baseline glycemic control who developed SIH, there was a significant association with adverse outcomes, including increased DCI rates (31.9 % vs 11.4 % in those without stress hyperglycemia, p = 0.021) and prolonged hospital stays.

Conclusions: Patients with elevated HbA1c demonstrated significantly higher rates of delayed cerebral ischemia (DCI), prolonged ICU stay, and poor functional outcomes. A high stress hyperglycemia ratio (SHR) > 1.14 is associated with 3.6 times greater odds of developing DCI when compared to patients having a normal SHR in patients with normal baseline glycemic control.