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

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)301-308
Number of pages8
JournalEuropean Stroke Journal
Volume8
Issue number1
DOIs
StatePublished - Mar 2023
Externally publishedYes

Keywords

  • Aneurysmal subarachnoid haemorrhage
  • VPS dependency
  • hydrocephalus
  • hyperglycaemia
  • risk factors

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