Hyperglycemia Predicts Adverse Outcomes in Patients With Intracerebral Hemorrhage

Several poster presentations this week confirm that hyperglycemia is a risk factor for poor outcomes in patients with intracerebral hemorrhage (ICH). Odufuye et al,¹ for example, reported that hyperglycemia is associated with increased risk of early death in patients with spontaneous ICH. They studied 181 patients who presented to the emergency department with spontaneous ICH and whose blood glucose levels were measured at presentation. A history of diabetes mellitus was present in 41 of the patients (23%).

Of the 47 patients who died within 7 days of presentation, 9 (19%) had a history of diabetes mellitus. Patients who died had significantly higher blood glucose levels at presentation than those who survived (median blood glucose level, 191 mg/dL vs 126 mg/dL). Patients with a blood glucose level higher than 200 mg/dL were 5 times more likely to die than those with levels lower than 200 mg/dL.

The association between blood glucose level and mortality was even stronger when the analysis focused on patients who did not have diabetes: the risk of death was 22 times higher in those with blood glucose levels higher than 200 mg/dL than in those with levels under 200 mg/dL.
 In a different presentation, Veena et al² reported findings on 185 patients who presented to the emergency department with ICH. The median patient age was 72 years, and the median blood glucose level was 141.5 mg/dL. The investigators found that higher blood glucose levels were associated with worse functional outcome within 7 days of presentation.

Hyperglycemia also appears to be associated with increased edema progression and increased mortality in patients with acute ICH. Ezzeddine et al³ retrospectively analyzed data from 30 patients with acute ICH who had undergone CT scanning within 24 hours of the onset of symptoms and again after 3 to 7 days. Patients were categorized as having high (> 140 mg/dL) or normal (≤ 140 mg/dL) glucose levels based on the average daily glucose level measured between the 2 CT evaluations. These 2 groups did not differ significantly in terms of age, history of hypertension, admission Glascow coma scale, or hemorrhage volume.

Compared with the 19 patients who had normal glucose levels, the 11 patients with high glucose levels had more hematoma expansion (23 mL vs 5 mL) and a higher in-hospital mortality rate (45% vs 5%).

The risk of symptomatic intracranial hemorrhage is increased in patients who are receiving thrombolytic therapy for ischemic stroke. According to Taqi et al,⁴ the best clinical predictors of this complication are hyperglycemia and patient age of 80 years or more. They presented data on 74 patients (mean age, 59 years) with acute ischemic stroke who had received intravenous recombinant tissue plasminogen activator (mean onset-to-needle time, 141 minutes).

Symptomatic intracranial hemorrhage developed in 4.5% of patients. Univariate and multivariate logistical regression analysis indicated that patient age of 80 years or more and blood glucose levels of 200 mg/dL or higher were significant risk factors for symptomatic intracranial hemorrhage.
 

References:

References

1. Odufuye AO, Jain AR, Bellolio FM, et al. Hyperglycemia as a predictor of early mortality in intracerebral hemorrhage. [P02.043] Poster Session II: Prognosis in Intracerebral Hemorrhage, Tuesday, April 28.
2. Veena M, Jain A, Adetolu O, et al. Effect of blood glucose level on functional outcome of patients presenting with intracerebral hemorrhage. [P02.058] Poster Session II: Intracerebral and Subarachnoid Hemorrhage, Tuesday, April 28, 2009.
3. Ezzeddine MA, Tariq N, Vazquez G, et al. Hyperglycemia may be associated with edema progression in acute intracerebral hemorrhage. [P08.141] Poster Session VIII: Stroke: Bench to Bedside, Thursday, April 30, 2009.
4. Taqi MA, Dellinger CA, Wahba MN, Giraldo EA. Clinical predictors of symptomatic intracranial hemorrhage after late intravenous thrombolysis for acute ischemic stroke. [P02.091] Poster Session II: Acute Stroke, Tuesday, April 28, 2009.