Department of Neurological Surgery, Columbia University, 710 West 168th Street, Room 431, New York, NY 10032, USA.
Stroke. 2011 Jul;42(7):1883-8. doi: 10.1161/STROKEAHA.110.608166. Epub 2011 Jun 2.
Hyperglycemia after spontaneous intracerebral hemorrhage (ICH) is associated with poor outcome, but the pathophysiology of ICH-induced glucose dysregulation remains unclear. We sought to identify clinical and radiographic parameters of ICH that are associated with admission hyperglycemia.
Patients admitted to the Columbia University Medical Center Neurological Intensive Care Unit with spontaneous ICH between January 2009 and September 2010 were prospectively enrolled in the ICH Outcomes Project. Clinical, radiographic, and laboratory data were collected prospectively. Receiver operating characteristic analysis was used to identify the glucose level with optimal sensitivity and specificity for in-hospital mortality. Logistic and linear regression analyses were used to identify independent predictors of outcome measures where appropriate.
One hundred four patients admitted during the study period were included in the analysis. Mean admission glucose level was 8.23 ± 3.15 mmol/L (3.83 to 18.89 mmol/L) and 23.2% had a history of diabetes mellitus. Admission glucose was significantly associated with discharge (P=0.003) and 3-month mortality (P=0.002). Critical hyperglycemia defined at 10 mmol/L independently predicted discharge mortality (P=0.027; OR, 4.381; 95% CI, 1.186 to 16.174) and 3-month mortality (P=0.011; OR, 10.95; 95% CI, 1.886 to 62.41). Admission intraventricular extension score (P=0.038; OR, 1.117; 95% CI, 1.043 to 1.197) and diabetes mellitus (P=0.002; OR, 5.530; 95% CI, 1.833 to 16.689) were independent predictors of critical hyperglycemia. The intraventricular extension score (B=0.115, P=0.001) linearly correlated with admission glucose level (R=0.612, P=0.001) after adjusting for other clinical variables.
Admission hyperglycemia after spontaneous ICH is associated with poor outcome and potentially related to the presence and severity of intraventricular extension.
自发性脑出血（ICH）后发生的高血糖与不良预后相关，但 ICH 引起的血糖调节失常的病理生理学机制仍不清楚。我们试图确定与入院时高血糖相关的 ICH 的临床和影像学参数。
2009 年 1 月至 2010 年 9 月期间，前瞻性纳入哥伦比亚大学医学中心神经重症监护病房收治的自发性 ICH 患者入组 ICH 结局项目。前瞻性收集临床、影像学和实验室数据。采用受试者工作特征曲线分析确定与院内死亡率具有最佳敏感性和特异性的血糖水平。在适当的情况下，采用逻辑和线性回归分析确定结局指标的独立预测因子。
在研究期间，共有 104 例患者纳入分析。入院时的平均血糖水平为 8.23±3.15mmol/L（3.83 至 18.89mmol/L），23.2%的患者有糖尿病病史。入院血糖与出院（P=0.003）和 3 个月死亡率（P=0.002）显著相关。定义为 10mmol/L 的临界高血糖独立预测出院死亡率（P=0.027；OR，4.381；95%CI，1.186 至 16.174）和 3 个月死亡率（P=0.011；OR，10.95；95%CI，1.886 至 62.41）。入院时脑室扩展评分（P=0.038；OR，1.117；95%CI，1.043 至 1.197）和糖尿病（P=0.002；OR，5.530；95%CI，1.833 至 16.689）是临界高血糖的独立预测因子。在校正其他临床变量后，脑室扩展评分（B=0.115，P=0.001）与入院时血糖水平呈线性相关（R=0.612，P=0.001）。
自发性 ICH 后入院时的高血糖与不良预后相关，且可能与脑室扩展的存在和严重程度有关。
