Kimura Kazumi, Iguchi Yasuyuki, Inoue Takeshi, Shibazaki Kensaku, Matsumoto Noriko, Kobayashi Kazuto, Yamashita Shinji
Department of Stroke Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki-city, Okayama, 701-0192, Japan.
J Neurol Sci. 2007 Apr 15;255(1-2):90-4. doi: 10.1016/j.jns.2007.02.005. Epub 2007 Mar 12.
It is unclear whether hyperglycemia on admission in patients with acute intracerebral hemorrhage (ICH) increases the risk of early death.
100 consecutive patients (median age, 67.8 years) with acute supratentorial ICH within 24 h of onset were prospectively enrolled. Clinical characteristics and plasma glucose were assessed in all patients. ICH volume was measured on admission CT (<24 h) and follow-up CT (<48 h) scans. Patients were divided into two groups: the death group, who died within 14 days of onset, and the survival group. The association between early death and clinical characteristics were investigated by multivariate logistic regression analysis.
The death group consisted of 11 patients (median age, 77 years), while the survival group consisted of 89 patients (median age, 67 years). The admission plasma glucose level and the ICH volume were higher in the death group than in the survival group (glucose: death, 205 mg/dl vs. survival, 131 mg/dl, p<0.0001; and ICH volume: survival, 13.6+/-15.3 ml vs. death 101.1+/-48.7 ml, p<0.0001). Using receiver operating characteristic (ROC) curve, cut-off values that predicted early death were 150 mg/dl for the glucose level and >20 ml for the initial IVH volume. On multivariate logistic regression analysis, admission plasma glucose level>150 mg/dl (OR 37.5, CI 1.4-992.7, p=0.03) and IVH volume>20 ml (OR 64.6, CI 1.3-3173.5, p=0.04) were independent factors associated with early death.
Admission hyperglycemia may independently increase the risk of early death in acute spontaneous intracerebral hemorrhage.
急性脑出血（ICH）患者入院时的高血糖是否会增加早期死亡风险尚不清楚。
前瞻性纳入100例发病24小时内的急性幕上脑出血连续患者（中位年龄67.8岁）。评估所有患者的临床特征和血糖水平。在入院CT（<24小时）和随访CT（<48小时）扫描上测量ICH体积。患者分为两组：发病14天内死亡的死亡组和存活组。通过多因素逻辑回归分析研究早期死亡与临床特征之间的关联。
死亡组11例患者（中位年龄77岁），存活组89例患者（中位年龄67岁）。死亡组入院时血浆葡萄糖水平和ICH体积高于存活组（葡萄糖：死亡组205mg/dl，存活组131mg/dl，p<0.0001；ICH体积：存活组13.6±15.3ml，死亡组101.1±48.7ml，p<0.0001）。使用受试者工作特征（ROC）曲线，预测早期死亡的血糖水平临界值为150mg/dl，初始IVH体积临界值>20ml。多因素逻辑回归分析显示，入院血浆葡萄糖水平>150mg/dl（OR 37.5，CI 1.4-992.7，p=0.03）和IVH体积>20ml（OR 64.6，CI 1.3-3173.5，p=0.04）是与早期死亡相关的独立因素。
入院时高血糖可能独立增加急性自发性脑出血患者早期死亡的风险。
