Hyperglycemia During Cerebral Aneurysm Surgery Impairs Cognition

Patients with elevated blood glucose levels at the time of cerebral aneurysm clipping are at increased risk for impaired cognition and possibly deficits in gross neurologic function at 3-month follow-up, according to a new study.

Researchers at the Mayo Clinic (Rochester, MN, USA) analyzed data from 1000 patients who participated in the Intraoperative Hypothermia for Aneurysm Trial. The subjects, who were recruited between February 2000 and April 2003, underwent aneurysm clipping within 14 days of a subarachnoid hemorrhage. Gross neurologic and neuropsychologic function was evaluated at 3 months after surgery using certified observers and standardized assessment instruments. Intraoperative blood glucose concentrations, measured once when the aneurysm clip was placed, were correlated with neurologic outcome using both univariable and multivariable logistic regression analyses.

The study results showed that blood glucose levels at the time of clipping ranged from 59 to 331 mg/dL; a glucose level of 129 mg/dL or more was predictive of impaired cognition at 3 months. With levels above 152 mg/dL, the risk of gross neurologic dysfunction increased as well. Patients with glucose levels of 129 mg/dL or more also had longer intensive care unit (ICU) stays than patients with lower levels, but had comparable total hospital stays and likelihood of home discharge. The study was published in the April 2008 issue of the Mayo Clinic Proceedings.

"More research is needed to determine whether the association we identified represents cause and effect and to establish the critical timing of hyperglycemia,” said lead author Dr. Jeffrey J. Pasternak, and colleagues of the department of anesthesiology. "Until such research is completed, we contend that our findings--when taken in the context of an extensive body of related research--argue in favor of rigid glucose control in patients with aneurysmal subarachnoid hemorrhage who undergo aneurysm clipping surgery.”


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