The effects of hyperglycemia on outcomes in surgical high-grade glioma patients
Introduction
Due to the limited survival of patients with high grade glioma (HGG), reducing post-operative complications and need for re-hospitalization is critical to ensure optimal quality of life [1,2]. Elevated blood glucose and diabetes is a known risk factor for surgical complications and morality [3,4]. Patients presenting with acute ischemic stroke, subarachnoid hemorrhage, and traumatic brain injury all have worse outcomes such as worsening neurological function, increased nosocomial infections, and longer hospitalizations with inpatient hyperglycemia or diabetes [[5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]]. Therefore, glucose control is now a reported quality metric for both the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare and Medicaid Services (CMS) [16].
Expert recommendation for the upper limit of serum glucose varies based on acuity of care (140–180 mg/dL for critically ill patients and <140 mg/dL for non-critically ill patients) [17]. In patients with glioblastoma (GBM) elevated blood glucose is associated with poorer neurologic outcomes and reduced survival [14,18]. However, the glucose value that predicts worsened outcomes and the association between hyperglycemia and reported quality metrics has not been described. Due to the importance of complication avoidance in the post-operative period, which can delay needed medical treatment for HGG patients, we aimed to assess the role of hyperglycemia in HGG patients undergoing surgical resection. The purpose of this study was to define the glucose values associated with an increase in complication rates in post-operative HGG patients so that treatment for hyperglycemia could be targeted to a goal glucose value.
Section snippets
Patient population
The institution’s Institutional Review Board (IRB) approved this study. Electronic medical records of patients who underwent a craniotomy for resection of HHG at the institution from May 2011 to December 2014 were retrospectively reviewed. Information collected included patient sex, age at diagnosis, pre-operative presenting symptoms, pre-operative medical comorbidities, pre-operative anti-hyperglycemic agents, pre-operative calculated KPS, pre-operative MRI lesion enhancing volume, cerebral
Results
During the study period, 164 patients underwent craniotomy for surgical resection of a HGG with 108 patients having sufficient post-operative blood glucose monitoring. Out of these 108 patients, 47 were female and 61 were male with a median age of 60 years old (Table 1). Blood glucose values were obtained over the first 2 post-operative days and the average length of stay for the entire group was seven days (includes any pre-operative days). Over half were current or former smokers, and 85 were
Discussion
In this study, we investigated the association between severe post-operative complications, mortalities, and 30-day readmissions with post-operative hyperglycemia. We found that a median post-operative blood glucose value above 167.0 mg/dL (9.27 mmol/L) or higher was associated with an increase in rates of severe post-operative complication risk and a median post-operative blood glucose value above 163.0 mg/dL (9.05 mmol/L) was associated with an increase of 30-day readmission. Of the
Conclusions
This study demonstrates that persistent hyperglycemia with median blood glucose values greater than 167 mg/dL (9.27 mmol/L) within the post-operative period is associated with increased post-operative complications and a median blood glucose greater than 163 mg/dL (9.05 mmol/L) is associated with increased 30-day hospital readmission. Recognition of hyperglycemia is important to patient outcomes as indicated in this study and is substantiated by the findings of several other studies. Therefore,
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
References (21)
- et al.
Hyperglycemia is independently associated with post-operative function loss in patients with primary eloquent glioblastoma
J. Clin. Neurosci.
(2012) - et al.
Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma
N. Engl. J. Med.
(2005) - et al.
Maintenance therapy with tumor-treating fields plus temozolomide vs temozolomide alone for glioblastoma: a randomized clinical trial
JAMA
(2015) - et al.
Prevalence of hyper- and hypoglycemia among inpatients with diabetes: a national survey of 44 U.S. Hospitals
Diabetes Care
(2007) - et al.
Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes
J. Clin. Endocrinol. Metab.
(2002) - et al.
Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long-term follow up study
BMJ
(1997) - et al.
Hyperglycemia in acute stroke
Stroke
(2004) - et al.
Persistent poststroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome
Stroke
(2003) - et al.
Relationship between hyperglycemia and symptomatic vasospasm after subarachnoid hemorrhage
Crit. Care Med.
(2005) - et al.
Hyperglycemia after SAH: predictors, associated complications, and impact on outcome
Stroke
(2006)
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