Hyperglycemia independently increases the risk of early death in acute spontaneous intracerebral hemorrhage

doi:10.1016/j.jns.2007.02.005

Journal of the Neurological Sciences

Volume 255, Issues 1–2, 15 April 2007, Pages 90-94

https://doi.org/10.1016/j.jns.2007.02.005 Get rights and content

Abstract

Background

It is unclear whether hyperglycemia on admission in patients with acute intracerebral hemorrhage (ICH) increases the risk of early death.

Methods

100 consecutive patients (median age, 67.8 years) with acute supratentorial ICH within 24 h of onset were prospectively enrolled. Clinical characteristics and plasma glucose were assessed in all patients. ICH volume was measured on admission CT (< 24 h) and follow-up CT (< 48 h) scans. Patients were divided into two groups: the death group, who died within 14 days of onset, and the survival group. The association between early death and clinical characteristics were investigated by multivariate logistic regression analysis.

Results

The death group consisted of 11 patients (median age, 77 years), while the survival group consisted of 89 patients (median age, 67 years). The admission plasma glucose level and the ICH volume were higher in the death group than in the survival group (glucose: death, 205 mg/dl vs. survival, 131 mg/dl, p < 0.0001; and ICH volume: survival, 13.6 ± 15.3 ml vs. death 101.1 ± 48.7 ml, p < 0.0001). Using receiver operating characteristic (ROC) curve, cut-off values that predicted early death were 150 mg/dl for the glucose level and > 20 ml for the initial IVH volume. On multivariate logistic regression analysis, admission plasma glucose level > 150 mg/dl (OR 37.5, CI 1.4–992.7, p = 0.03) and IVH volume > 20 ml (OR 64.6, CI 1.3–3173.5, p = 0.04) were independent factors associated with early death.

Conclusion

Admission hyperglycemia may independently increase the risk of early death in acute spontaneous intracerebral hemorrhage.

Introduction

Spontaneous intracerebral hemorrhage (ICH) accounts for 10% to 15% of stroke; the mortality rate is high, and it is associated with a poor functional outcome [1]. A large initial ICH volume and early hematoma growth are associated with neurological deterioration and poor outcome [1], [2], [3]. The following factors have been identified as being predictors of early hematoma growth: heavy drinking; low fibrinogen level; consciousness disturbance; poorly controlled diabetes; use of an antithrombotic agent; high fever; and high blood pressure [1], [2], [3].

On the other hand, in patients with acute ischemic stroke and subarachnoid hemorrhage, hyperglycemia has been reported to be a predictor of poor outcome [4], [5], [6], [7], [8]. Hyperglycemia after acute stroke may be due to several mechanisms, such as acute stress, autonomic hormonal changes, and metabolic alteration as a result of brain injury [9]. Therefore, we hypothesized that hyperglycemia at admission was associated with patients' poor outcome in acute spontaneous intracerebral hemorrhage as well as ischemic stroke. We studied that hyperglycemia independently increased the risk of early death in acute spontaneous intracerebral hemorrhage.

Section snippets

Methods

Consecutive patients with spontaneous supratentorial ICH who were admitted to our stroke center within the first 24 h of onset from April 2004 to June 2006 were enrolled. A detailed history of vascular risk factors, drug abuse, and concomitant medication was obtained from each patient. Patients with ICH related to vascular malformation were excluded from this study. NIH Stroke Scale (NIHSS) scores were recorded to assess the level of consciousness and the neurological status on admission (<

Results

A total of 100 patients (68.7 ± 12.7 years old, 43 female) was enrolled in the present study. The mean ± SD of the NIHSS score on admission for all patients was 12.4 ± 7.8. The locations of the hematoma were: lobar in 17 patients, the putamen in 33, the thalamus in 44, and other locations in 6. Eleven patients (11%) died within 14 days of onset because of brain herniation. The interval from stroke onset to death was 4.1 ± 3.5 days; in these patients, the location of the hematoma was in the putamen in 4

Discussion

In the present study, admission hyperglycemia was identified as an independent predictor of early death. Patients with an ischemic stroke or subarachnoid hemorrhage who were hyperglycemic tend to have a worse neurological outcome [4], [5], [6], [7], [8]. Furthermore, hyperglycemia was associated with the increased rate of hemorrhagic transformation with thrombolytic therapy [12], [13], [14], [15], [16]. In animal experiments of cerebral ischemia, the deleterious effects of hyperglycemia appear

Acknowledgments

This study was supported in part by Research Grants for Cardiovascular Disease (18C-2) from the Ministry of Health, Labor and Welfare of Japan.

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Hyperglycemia independently increases the risk of early death in acute spontaneous intracerebral hemorrhage

Abstract

Background

Methods

Results

Conclusion

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgments

J Neurol Sci

J Neurol Sci

Ann Emerg Med

Spontaneous intracerebral hemorrhage

N Engl J Med

Predisposing factors to enlargement of spontaneous intracerebral hematoma

Stroke

Blood pressure management in acute intracerebral hemorrhage: relationship between elevated blood pressure and hematoma enlargement

Stroke

Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview

Stroke

Hyperglycemia after SAH: predictors, associated complications, and impact on outcome

Stroke

Predictors of in-hospital mortality and attributable risks of death after ischemic stroke: the German Stroke Registers Study Group

Arch Intern Med

The role of hyperglycemia in acute stroke

Arch Neurol

Hyperglycemia, insulin, and acute ischemic stroke: a mechanistic justification for a trial of insulin infusion therapy

Stroke

The ABCs of measuring intracerebral hemorrhage volumes

Stroke

Early hemorrhage growth in patients with intracerebral hemorrhage

Stroke

Admission glucose level and clinical outcomes in the NINDS rt-PA Stroke Trial

Neurology

Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke

Neurology