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
  • Source
    • "Stead LG 2010 [28] Prospective study USA 237 >140 mg/dL 7 days mortality Age, stroke severity (NIHSS), hemorrhage, and hematoma volume. Samiullah S 2010 [27] Prospective study Pakistan 450 >7 mmol/L in-hospital mortality Age, sex, volume of haematoma, Glasgow Coma Scale, hyperglycaemia and site of haematoma, age and volume of haematoma. Di Napoli M 2011 [25] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Hyperglycemia may be associated with worse functional outcomes in patients with primary intracerebral hemorrhage. We performed a systematic review and meta-analysis to investigate the relationship between hyperglycemia and mortality risk in patients with primary intracerebral hemorrhage. We searched PubMed and Embase databases for studies investigating the association between hyperglycemia and mortality risk in patients with primary intracerebral hemorrhage. We estimated the pooled relative risk (RR) with its 95 % confidence interval (95 % CI) to assess the impact of hyperglycemia on mortality risk. Seventeen studies with a total of 6527 primary intracerebral hemorrhage patients were included. Meta-analysis of those studies showed that hyperglycemia significantly increased risk of mortality in patients with primary intracerebral hemorrhage (RR = 2.36, 95 % CI 1.79-3.12). Subgroup analysis by time of follow-up showed that hyperglycemia significantly increased risk of short-term mortality (RR = 3.97, 95 % CI 2.13-7.43) and long-term mortality (RR = 1.53, 95 % CI 1.14-2.05). The RR of mortality for per 1-mmol/L increment in glucose level was 1.14 (95 % CI 1.06-1.22). In patients with primary intracerebral hemorrhage, hyperglycemia significantly increases risk of both short-term mortality and long-term mortality.
    Full-text · Article · May 2015 · Molecular Neurobiology
  • 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.
    Full-text · Article · Jul 2013 · Diabetes care
  • Source

    Full-text · Article · Jun 2012 · Clinical medicine (London, England)
Show more