Highest In-Hospital Glucose Measurements are Associated With Neurological Outcomes After Intracerebral Hemorrhage

J Stroke Cerebrovasc Dis. 2018 Oct;27(10):2662-2668. doi: 10.1016/j.jstrokecerebrovasdis.2018.05.030. Epub 2018 Jul 22.

Abstract

Background and purpose: The relationship between in-hospital hyperglycemia and neurological outcome after intracerebral hemorrhage (ICH) is not well studied.

Methods: We analyzed the relationships between pre-hospital and hospital variables including highest in-hospital glucose (HIHGLC) and discharge Glasgow Coma Scale (GCS), discharge Modified Rankin Scale (MRS) and 3-month MRS using a single-institution cohort of ICH patients between 2013 and 2015.

Results: There were 106 patients in our sample. Mean HIHGLC was 154 ± 58 mg/dL for patients with discharge GCS of 15 and 180 ± 57 mg/dL for patients with GCS < 15; 146 ± 55 mg/dL for patients with discharge MRS 0-3 and 175 ± 58 mg/dL for patients with discharge MRS 4-6; and 149 ± 52 mg/dL for patients with 3-month MRS of 0-3 and 166 ± 61 mg/dL for patients with 3-month MRS of 4-6. On univariate analysis, discharge GCS was associated with HIHGLC (P = .01), age (P = .006), ICH volume (P = .008), and length of stay (LOS) (P = .01); discharge MRS was associated with HIHGLC (P < .001), age (P < .001), premorbid MRS (P = .046), ICH volume (P < .001), and LOS (P < .001); and 3-month MRS was associated with HIHGLC (P = .006), discharge MRS (P < .001), age (P = .001), sex (P = .002), ICH volume (P = .03), and length of stay (P = .004). On multivariate analysis, discharge GCS only had a significant relationship with ICH volume (odds ratio [OR] .949, .927-.971); discharge MRS had a significant relationship with age (OR 1.043, 1.009-1.079), premorbid MRS (OR 2.622, 1.144-6.011), and ICH volume (OR 1.047, 1.003-1.093); and 3-month MRS only had a significant relationship with age (OR 1.039, 1.010-1.069).

Conclusions: The relationship between in-hospital hyperglycemia and neurological outcomes in ICH patients was meaningful on univariate, but not multivariate, analysis. Glucose control after ICH is important.

Keywords: Intracerebral hemorrhage; glucose; hyperglycemia; outcome.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Blood Glucose / metabolism*
  • Cerebral Hemorrhage / diagnosis
  • Cerebral Hemorrhage / physiopathology*
  • Cerebral Hemorrhage / therapy
  • Databases, Factual
  • Disability Evaluation
  • Female
  • Glasgow Coma Scale
  • Humans
  • Hyperglycemia / blood*
  • Hyperglycemia / complications
  • Hyperglycemia / diagnosis
  • Hyperglycemia / therapy
  • Length of Stay
  • Male
  • Middle Aged
  • Patient Admission*
  • Patient Discharge
  • Prognosis
  • Prospective Studies
  • Recovery of Function
  • Retrospective Studies
  • Risk Factors
  • Time Factors

Substances

  • Biomarkers
  • Blood Glucose