Emergency Department hyperglycemia as a predictor of early mortality and worse functional outcome after intracerebral hemorrhage.
BACKGROUND
We have previously reported the association of hyperglycemia and mortality after ischemic stroke. This study attempts to answer the hypothesis, if hyperglycemia at arrival, is associated with early mortality and functional outcome in patients with acute non-traumatic intracerebral hemorrhage (ICH).


METHODS
The study cohort consisted of 237 patients who presented to the ED with ICH and had blood glucose measured on ED presentation. The presence of hyperglycemia on presentation was correlated with outcome measures including volume of hematoma, intraventricular extension of hematoma (IVE), stroke severity, functional outcome at discharge, and date of death.


RESULTS
Of the cohort of 237 patients, a total of 47 patients had prior history of Diabetes Mellitus (DM). Median blood glucose at presentation was 140 mg/dl (Inter-quartile range 112-181 mg/dl). DM patients had higher glucose levels on arrival (median 202 mg/dl for DM vs. 132.5 mg/dl for non-DM, P < 0.0001). Higher blood glucose at ED arrival was associated with early mortality in both non-diabetics and diabetics (P < 0.0001). Higher blood glucose was associated with poor functional outcome in non-DM patients(P < 0.0001) but not in DM patients (P = 0.268). In the logistic regression model, after adjustment for stroke severity, hematoma volume, and IVE of hemorrhage, higher initial blood glucose was a significant predictor of death (P = 0.0031); as well as bad outcome in non-DM patients (P = 0.004).


CONCLUSIONS
Hyperglycemia on presentation in non-diabetic patients is an independent predictor of early mortality and worse functional outcome in patients with intracerebral hemorrhage.
Stead
Latha G
LG
Department of Emergency Medicine, Mayo Clinic, College of Medicine, Rochester, MN, USA. stead.latha@mayo.edu
Jain
Anunaya
A
Bellolio
M Fernanda
MF
Odufuye
Adetolu
A
Gilmore
Rachel M
RM
Rabinstein
Alejandro
A
Chandra
Raghav
R
Dhillon
Ravneet
R
Manivannan
Veena
V
Serrano
Luis A
LA
Yerragondu
Neeraja
N
Palamari
Balavani
B
Jain
Minal
M
Decker
Wyatt W
WW
D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D002543:Cerebral Hemorrhage / Q000097:blood / Q000150:complications* / Q000401:mortality*; D015331:Cohort Studies; D048909:Diabetes Complications / Q000097:blood; D004636:Emergency Service, Hospital; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012372:ROC Curve; D016414:Resuscitation Orders; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome
D001786:Blood Glucose
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