3.1 Basic data, Biochemistry tests, Neuroimages, 30 days mortality and DCI occurrence (Table 2)
For biochemistry tests, the patients whose average 14-day glucose were bad-controlled have some commons, such as higher Age (59.09±11.95), Diabetes history, higher SBP (162.91±20.85) when admission, relatively higher BUN (5.50±1.80), higher HA1c (7.12±1.65), BGV (0.32±0.11), higher Hunt-Hess Score (2.59±0.97), lower GCS Score (10.68±4.23), Hydrocephalus in Forth ventricle, Third ventricle and Lateral ventricles. Bad controlled group has the highest mortality (15.91%), then unstable (13.04%), well-controlled (6.45%), and stable group (1.42%). The unstable group has the highest incidence of DCI (39.13%), then bad-controlled (29.55%), the stable (17.92%) and well-controlled (17.74%).
Table 2. Basic data, Biochemistry tests, Neuroimages, 30-days mortality and DCI occurrence
|
stable
(n=212)
|
unstable
(n=23)
|
Well-controlled
(n=62)
|
Bad-controlled
(n=44)
|
F/x2
|
P
|
Age
|
53.70±12.50
|
56.65±11.69
|
59.19±12.19
|
59.09±11.95
|
4.673
|
0.003
|
Sex
|
|
|
|
|
7.812
|
0.050
|
Male
|
103(48.58)
|
9(39.13)
|
18(29.03)
|
18(40.91)
|
|
|
Female
|
109(51.42)
|
14(60.87)
|
44(70.97)
|
26(59.09)
|
|
|
Diabetes
|
12(5.66)
|
3(13.04)
|
8(12.90)
|
29(65.91)
|
102.808
|
<0.001
|
Hypertension
|
119(56.13)
|
17(73.91)
|
40(64.52)
|
32(72.73)
|
6.589
|
0.086
|
SBP-adm.
|
148.03±21.26
|
155.83±17.07
|
153.81±24.91
|
162.91±20.85
|
6.412
|
<0.001
|
DBP-adm
|
86.84±13.63
|
87.74±12.90
|
85.90±16.06
|
86.89±15.27
|
0.114
|
0.952
|
Temp.-adm
|
36.76±0.79
|
36.81±0.52
|
36.91±0.56
|
36.95±0.42
|
1.384
|
0.248
|
Lab tests
|
|
|
|
|
|
|
AST
|
25.39±17.11
|
26.97±13.18
|
26.30±15.08
|
25.48±12.38
|
0.107
|
0.956
|
ALT
|
25.56±17.34
|
26.47±14.42
|
25.00±14.49
|
23.43±10.41
|
0.270
|
0.847
|
BUN
|
4.72±1.43
|
5.33±1.62
|
5.11±1.54
|
5.50±1.80
|
4.215
|
0.006
|
Cr
|
56.11±16.09
|
53.62±18.79
|
54.10±18.24
|
60.56±19.13
|
1.443
|
0.230
|
D-dimer
|
2.99±4.00
|
3.80±3.48
|
4.71±7.37
|
3.25±4.13
|
2.075
|
0.103
|
BNP
|
156.84±305.31
|
131.62±147.94
|
177.76±312.28
|
123.59±154.63
|
0.325
|
0.807
|
EF
|
64.52±5.96
|
64.26±4.39
|
64.50±3.68
|
65.79±4.84
|
0.591
|
0.622
|
HA1c
|
5.44±0.40
|
5.55±0.37
|
5.76±0.68
|
7.12±1.65
|
57.543
|
<0.001
|
BGV
|
0.13±0.06
|
0.32±0.11
|
0.15±0.06
|
0.23±0.10
|
56.862
|
<0.001
|
Hunt-Hess
|
2.01±0.88
|
2.30±1.02
|
2.52±0.97
|
2.59±0.97
|
8.225
|
<0.001
|
CT-Fisher
|
2.24±0.83
|
2.39±0.72
|
2.34±0.85
|
2.55±0.70
|
1.936
|
0.124
|
GCS
|
13.57±2.72
|
12.43±3.59
|
11.34±4.04
|
10.68±4.23
|
14.144
|
<0.001
|
Hydrocephalus
|
68(32.08)
|
11(47.83)
|
26(41.94)
|
19(43.18)
|
4.706
|
0.195
|
Forth ventricle
|
47(22.17)
|
12(52.17)
|
20(32.26)
|
12(27.27)
|
10.839
|
0.013
|
Third ventricle
|
17(8.02)
|
8(34.78)
|
14(22.58)
|
10(22.73)
|
20.633
|
<0.001
|
Lateral ventricles
|
103(48.58)
|
18(78.26)
|
40(64.52)
|
30(68.18)
|
13.832
|
0.003
|
Quadrigeminal cistern
|
17(8.02)
|
2(8.70)
|
7(11.29)
|
7(15.91)
|
2.832
|
0.418
|
Cisterna amibiens
|
65(30.66)
|
7(30.43)
|
19(30.65)
|
22(50.00)
|
6.483
|
0.090
|
Suprasellar cistern
|
115(54.25)
|
13(56.52)
|
43(69.35)
|
31(70.45)
|
7.179
|
0.066
|
Basilar cistern
|
130(61.32)
|
14(60.87)
|
45(72.58)
|
34(77.27)
|
5.921
|
0.116
|
Lateral fissure cistern
|
164(77.36)
|
17(73.91)
|
47(75.81)
|
40(90.91)
|
4.744
|
0.191
|
30 d mortality
|
3(1.42)
|
3(13.04)
|
4(6.45)
|
7(15.91)
|
20.224
|
<0.001
|
DCI
|
38(17.92)
|
9(39.13)
|
11(17.74)
|
13(29.55)
|
8.144
|
0.043
|
3.2 Multivariate logistic regression analysis, 30 days Mortality and DCI
Taking the 30 days Mortality or DCI occurrence during hospitalization as the dependent variable respectively, and age, gender, SBP at admission, history of Diabetes Mellitus, BUN, HA1c, BGV, Hunt-Hess GCS, Hydrocephalus in Forth ventricle, Third ventricle and Lateral ventricles as independent variable, multivariate Logistic regression analysis showed that unstable and bad-controlled group have higher 30 days Mortality and DCI incidence (Table 3.)
Table 3. Multivariate Logistic Regression Analysis for 30 days Mortality and DCI
Mortality
|
|
Crude Results
|
Adjusted Results†
|
Group
|
N(%)
|
Hazard Ratio (95% CI)
|
P-value
|
Hazard Ratio (95% CI)
|
P-value
|
|
Stable
|
3(1.4)
|
1.000
|
|
1.000
|
|
|
Unstable
|
3(13.0)
|
7.541(1.507-37.729)
|
0.014
|
14.033(1.971-99.921)
|
0.008
|
|
Well-controlled
|
4(6.5)
|
4.939(1.105-22.076)
|
0.037
|
4.881(0.780-30.534)
|
0.090
|
|
Bad-controlled
|
7(15.9)
|
10.487(2.694-40.818)
|
0.001
|
19.723(3.597-108.143)
|
0.001
|
|
DCI
|
|
Crude Results
|
Adjusted Results†
|
Group
|
N(%)
|
Odds Ratio (95% CI)
|
P-value
|
Odds Ratio (95% CI)
|
P-value
|
|
Stable
|
38(17.9)
|
1.000
|
|
1.000
|
|
|
Unstable
|
9(39.1)
|
2.944(1.187-7.298)
|
0.020
|
6.032(1.941-18.747)
|
0.002
|
|
Well-controlled
|
11(17.7)
|
0.988(0.471-2.070)
|
0.974
|
1.115(0.497-2.502)
|
0.792
|
|
Bad-controlled
|
13(29.53)
|
1.920(0.919-4.011)
|
0.083
|
2.889(1.247-6.691)
|
0.013
|
|
† Adjusted for age, gender, SBP at admission, history of Diabetes Mellitus, BUN, HA1c, BGV, Hunt-Hess GCS, Hydrocephalus in Forth ventricle, Third ventricle and Lateral ventricles
rom aneurysm SAH were included. People with SAH caused by vasculitis, trauma, or rupture of an arteriovenous malformation was excluded. There were 341 subjects (148 males, 43.4 %; 193 females, 56.6 %) were enrolled in this study. We have two experts to evaluate the occurrence of DCI, the Kappa value was 0.91 between the two experts. This retrospective study was approved by the Ethics Committee at the Tiantan Hospital in Beijing, in accordance with the Declaration of Helsinki. Our study was approved to collect data without requiring patient informed consent under the Waived Consent from the Ethics Committee at the Tiantan Hospital in Beijing (Ethics Approval Number: KY2019-060).
2.2 Clinical information
The following baseline characteristics were analyzed based on the data collected during the period of admission: sex, age, diabetes mellitus (DM), hypertension, glucose level, initial Glasgow Coma Scale (GCS) score, systolic blood pressure (SBP), diastolic blood pressure (DBP), temperature, treatment, surgery, mortality information and dates of death. Several indexes were collected as follows: AST, ALT, BUN, creatinine (Cr), D-dimer, BNP, EF, hemoglobin A1c (HA1c), blood glycemic variability (BGV), Hunt Hess, CT Fisher, hydrocephalus (Fourth ventricle, Third ventricle, Lateral ventricle, Quadrigeminal cistern, Ambiens cisterna, Suprasellar cistern, Sylvian fissure, Basilar cistern). The first day blood glucose level was taken immediately before any glucose management when admission. Then the other 13 days blood sample was taken around 6:00 am every morning as fasting blood glucose. These 14 days glucose value after SAH were collected and was divided into four groups - stable, unstable, well-controlled and bad controlled (Table 1). BGV was measured as glycated albumin/glycosylated hemoglobin ratio[13].
Table 1
Four groups of different glucose levels
Group | Glucose Level (mmol/L) |
---|
1st day | 2nd -14th day |
---|
Stable | < 7 | Always < 10 |
Unstable | < 7 | More than once ≥ 10 |
Well-controlled | ≥ 7 | Always < 10 |
Bad-controlled | ≥ 7 | More than once ≥ 10 |
2.3 Statistical analysis
All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS version 21.0 for Windows, SPSS, Chicago). Categorical variables were compared using Pearson Chi-square analysis or Fisher’s exact test. Continuous variables were compared using the ANOVA test or the Kruskal-Wallis rank-sum test. Multivariate logistic regression analysis was performed to determine the effects of the variables on 30 days mortality or DCI. All statistical tests were two-tailed, and p < 0.05 was considered to be statistically significant.