Frequency of stress hyperglycaemia and its' influence on the outcome of patients with spontaneous intracerebral haemorrhage

Department of Medicine, Liaquat University of Medical &Health Sciences, Jamshoro, Hyderabad.
Journal of the Pakistan Medical Association (Impact Factor: 0.41). 08/2010; 60(8):660-3.
Source: PubMed


To observe the frequency of admission hyperglycaemia and its influence on the outcome of patients with intracerebral haemorrhage.
This case series study included 450 consecutive patients received in medical wards at Liaquat University Hospital Jamshoro/Hyderabad with a diagnosis of Spontaneous Intracerebral Haemorrhage within 24 hours of their first stroke onset, between September 2006 to December 2008. The patients with haemorrhage secondary to brain tumours, trauma, haemorrhagic transformation of cerebral infarct, with previous history of haemorrhagic stroke, and patients with Glycosylated Haemoglobin greater than 8.5% were excluded from the study. Hyperglycaemia was defined as an admission or in-hospital fasting blood glucose level of 126 mg/dl (7 mmol/liter) or more or a random blood glucose level of 200 mg/dl (11.1 mmol/liter) or more on 2 or more determinations. The patients were divided into 2 broad groups, good outcome groups (i.e. patients who survived), and poor outcome group (patient died). Categorical variables such as age, sex, volume of haematoma, GCS score, presence of admission hyperglycaemia, Mean arterial pressure (MAP), and site of haematoma were expressed as percentage and frequency. Chi-square test was applied for comparing categorical variables such as hyperglycaemia, GCS score, and age with the outcome of the patients. Multivariate logistical regression analysis was done. A p-value 0.05 was considered as statistically significant. All calculations were done using SPSS version 16 (Chicago, IL, USA).
Of the 450 consecutive patients, 399 fulfilled the inclusion criteria. Males were 261(65.4%) and females 136 (36, 4%).Patients of over 65 years age numbered 222 (55.6%) and 177 (44.4%) were less than 65 years. Stress hyperglycaemia was present in 109 (27.3%) cases and 290 (72.7%) patients were normoglycaemic. Of the 109 patients who died during hospitalization, 59 (54.12%) had presented with admission hyperglycaemia (0.001).
Stress hyperglycaemia is a common finding in patients presenting with intracerebral haemorrhage. It is a marker of poor outcomes and higher mortality, more so in patients with no known history of diabetes.

Download full-text


Available from: Samiullah Shaikh, Oct 08, 2015
15 Reads
  • Source
    • "AMI diagnosis criteria met at least two of following: 1) the CK-MB isoenzyme and/or troponin-I concentration elevated above the hospital laboratory's myocardial infarction threshold; 2) persistent ST-T segment changes, new Q waves, or left bundle branch block occurred; 3) serious precordial chest pain lasting for 30 min or more. Stress hyperglycemia diagnosis criteria were as follows: 1) patients did not have a previous diabetes history, 2) admission or in-hospital fasting plasma glucose levels of 7 mmol/L or more in two or more tests (13), and 3) normal HbA1c values. "
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE To investigate the risk of acute myocardial infarction (AMI) following stress hyperglycemia after hip fracture.RESEARCH DESIGN AND METHODS From February 2007 to February 2012, we carried out a prospective observational analysis of 1,257 consecutive patients with no history of diabetes who suffered hip fractures. Fasting blood glucose (FBG) and glycosylated hemoglobin tests as well as electrocardiography, ultrasonic cardiography, and chest X-ray examinations were performed after admission. All selected hip fracture patients were divided into stress hyperglycemia and non-hyperglycemia groups according to their FBG, and the incidence of AMI was monitored.RESULTSAmong the patients enrolled, the frequency of stress hyperglycemia was 47.89% (602/1,257) and that of AMI was 9.31% (117/1,257), and the occurrence of AMI in the stress hyperglycemia group was higher than in the non-hyperglycemia group (12.46 vs. 6.41%, P < 0.05). In the stress hyperglycemia patients, FBG reached maximum levels at 2-3 d after hip fractures and then decreased gradually. The AMI incidence (62.67% [47/75]) of the stress hyperglycemia group was highest in the initial 3 d after hip fracture, significantly coinciding with the FBG peak time (P < 0.05). In all patients with AMI, non-ST-segment elevation myocardial infarction occurred more often than ST-segment elevation myocardial infarction (62.39% [73/117] vs. 37.61% [44/117]).CONCLUSIONS Stress-induced hyperglycemia after hip fracture increased the risk of AMI.
    Diabetes care 07/2013; 36(10). DOI:10.2337/dc13-0119 · 8.42 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of the study is to determine the prevalence of stress hyperglycemia and to investigate how thyroid and stress hormones alter during stress hyperglycemia in children admitted to pediatric emergency wards. A prospective cross-sectional study was conducted in children, less than 19 years old, who were admitted to pediatric emergency wards of Nemazee and Dastgheib Hospitals, Shiraz, Southern Iran. Those patients taking steroids, beta-agonists or intravenously administered glucose before venipuncture, and patients with diabetes mellitus (DM) or thyroid diseases were excluded. Children with blood glucose ≥150 mg/dL during admission were regarded as cases. The controls were age- and- sex- matched, euglycemic children. Stress hormones including cortisol, insulin, growth hormone, and prolactin were measured, and thyroid function was tested with a radioimmunoassay (RIA) method in all cases and controls. The resuts showed that among 1,054 screened children, 39 cases (3.7 %) had stress hyperglycemia and 89 controls were included in the study. The occurrence of hyperglycemia was independent of sex, but it occurred mostly in children under 6 years old. Hyperglycemia occurred more frequently in patients with a positive family history of DM (odds ratio = 3.2, 95 % CI = 1.3-7.9, and P = 0.009). There were no significant differences between cases and controls regarding any hormones except higher cortisol, and lower total T3 and T4 in cases compared with controls. Neither of cases developed diabetes in the 24-month follow-up period. These findings led us to the conclusion that stress hyperglycemia is occasionally seen in critically ill patients. Among the stress hormones measured, only cortisol increased during hyperglycemia. It seems that hyperglycemia is not an important risk factor for future diabetes.
    Endocrine 06/2012; 42(3). DOI:10.1007/s12020-012-9707-y · 3.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction and objectives Hyperglycemia at admission seems to identify a subgroup of patients with acute coronary syndromes with poorer outcome. The aim of this study was to evaluate the impact of the glycemic variation during hospitalization in long-term mortality in nondiabetic patients. Methods Retrospective study of 2043 consecutive patients without known diabetes mellitus admitted for acute coronary syndrome in a single coronary care unit from May 2007 through August 2013. The population was divided in quartiles regarding glycemia at admission (≤ 90 mg/dL, n = 374; 90-140 mg/dL, n = 1307; 141-180 mg/dL, n = 230; ≥ 181 mg/dL, n = 111) and the mortality rate quantified for patients with glycemic variation above/below the mean for their respective quartile. The median follow-up was about 1200 days. Results The all-cause mortality during follow-up was significantly and successively higher in the upper quartiles (9.1%, 9.7%, 13.5% and 18.9%; P = .007). Multivariate regression analysis showed that hyperglycemia at admission (≥ 181 mg/dL) was a strong independent predictor of mortality during follow-up (hazard ratio = 1.74; 95% confidence interval, 1.07-2.8; P = .027). In the fourth quartile (≥ 181 mg/dL), the mortality is higher in patients with higher variations of glycemia (37.5% vs 8.5%; P < .001). Conclusions Hyperglycemia at admission is a predictor of all-cause mortality in our population. The mortality is higher in patients with higher glycemic variations. More studies are needed to confirm these data. Full English text available
    Revista Espa de Cardiologia 01/2014; 68(1). DOI:10.1016/j.recesp.2014.01.031 · 3.79 Impact Factor
Show more