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

Abstract

Objective: To observe the frequency of admission hyperglycaemia and its influence on the outcome of patients with intracerebral haemorrhage.

Methods: 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).

Results: 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).

Conclusion: 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.