Comprehensive interpretation of hyperglycemia and hyperosmolality on the clinical outcomes among ischemic stroke patients.
BACKGROUND
Hyperglycemia and hyperosmolality are associated with poor outcomes among acute ischemic stroke (AIS) patients.


OBJECTIVE
We evaluated the association between hyperglycemia and hyperosmolality, as a combination measure, with poor outcome among AIS patients.


METHODS
We conducted a retrospective study of AIS patients admitted to the study hospital emergency department between January and December 2014. Hyperglycemia was defined as serum glucose >144 mg/dL, and hyperosmolality was defined as a serum osmolality >295 mOsm/kg. After excluding hypoglycemia and hypoosmolality, the enrolled patients were classified into the following 4 subgroups: normoglycemia-normoosmolality, hyperglycemia-normoosmolality (HGNO), normoglycemia-hyperosmolality (NGHO), and hyperglycemia-normoosmolality (HGHO). The primary outcome was poor neurological status at 6 months, which was defined as a modified Rankin scale score ≥2.


RESULTS
Six hundred seven patients were included. The primary outcome was 336 (55.4%), and it was highest in the HGNO group (69.6%, 103/148), followed by the HGHO group (67.9%, 53/78), the NGHO group (57.3%, 43/75) and the normoglycemia-normoosmolality group (44.7%, 137/306). The multivariable logistic regression analysis revealed that HGNO and HGHO remained significant factors, with primary outcomes (adjusted odds ratio, 2.08; 95% confidence interval, 1.16-3.71) and 2.93 (1.45-5.91), respectively), whereas NGHO was not a significant factor. Cases of extremely high sodium levels were few in the NGHO and HGHO groups, whereas considerable cases of extremely high glucose level were observed in the HGHO group.


CONCLUSIONS
Hyperglycemia was associated with poor outcome, even after excluding the effect of hyperosmolality. However, hyperosmolality without hyperglycemia was not associated with poor outcome. An additive effect, likely reflecting severe hyperglycemia, was observed.
Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-si, Republic of Korea.
Seunghun
S
Ock
Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-si, Republic of Korea. Electronic address: akynei@naver.com.
Sion
S
Jo
Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-si, Republic of Korea.
Jae Baek
JB
Lee
Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-si, Republic of Korea.
Youngho
Y
Jin
Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-si, Republic of Korea.
Taeoh
T
Jeong
Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-si, Republic of Korea.
Jaechol
J
Yoon
National Cancer Control Institute, National Cancer Center, Goyang-si, Kyunggi-do, Republic of Korea.
Boyoung
B
Park
D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D001806:Blood Urea Nitrogen; D002545:Brain Ischemia / Q000150:complications; D002097:C-Reactive Protein / Q000378:metabolism; D003404:Creatinine / Q000097:blood; D004185:Disability Evaluation; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000097:blood* / Q000209:etiology; D009994:Osmolar Concentration; D011379:Prognosis; D012189:Retrospective Studies; D020521:Stroke / Q000097:blood* / Q000209:etiology; D013997:Time Factors
D001786:Blood Glucose; D002097:C-Reactive Protein; D003404:Creatinine; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human