Skip to main content
AAN.com
Articles
July 9, 2002

Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke

July 9, 2002 issue
59 (1) 67-71

Abstract

Background: Hyperglycemia at the time of acute ischemic stroke has been linked to worse outcome in both human and animal studies.
Objective: To describe the prevalence and severity of hyperglycemia on hospital admission among acute ischemic stroke patients, to examine the independent relationship of admission hyperglycemia to all-cause mortality, and to document the inpatient management of hyperglycemia.
Methods: Patients hospitalized with acute ischemic stroke at one hospital from July 1993 to June 1998 (n = 656) were identified. Demographic data, diagnoses, and blood glucose (BG) values were retrieved from the electronic medical record system. Admission stroke severity, fingerstick BG results, and new diabetes diagnoses were obtained by chart review. Hyperglycemia was defined as admitting random serum BG ≥ 130 mg/dL. Hazard ratios (HR) for 30-day, 1-year, and 6-year mortality were calculated using multivariable Cox regression models.
Results: Hyperglycemia at admission to hospital was present in 40% of patients with acute stroke. Patients with hyperglycemia were more often women and more likely to have prior diagnoses of diabetes and heart failure. Almost all of these patients remained hyperglycemic during their hospital stay (mean BG = 206 mg/dL), and 43% received no inpatient hypoglycemic drugs. Hyperglycemic patients had longer hospital stay (7 vs 6 days, p = 0.015) and higher inpatient hospital charges ($6,611 vs $5,262, p < 0.001). Hyperglycemia independently increased the risk for death at 30 days (HR 1.87, p ≤ 0.01), 1 year (HR 1.75, p ≤ 0.01), and 6 years after stroke (HR 1.41, p ≤ 0.01).
Conclusions: Admitting hyperglycemia was common among patients with acute ischemic stroke and was associated with increased short- and long-term mortality and with increased inpatient charges. Inpatient blood glucose management was suboptimal in this hospital. A trial of intensive treatment of hyperglycemia should be considered.

Get full access to this article

View all available purchase options and get full access to this article.

References

1.
Woo E, Chan YW, Yu YL, Huang CY. Admission glucose level in relation to mortality and morbidity outcome in 252 stroke patients. Stroke . 1988; 19: 185–191.
2.
Topic E, Pavlicek I, Brinar V, Korsic M. Glycosylated haemoglobin in clarification of the origin of hyperglycaemia in acute cerebrovascular accident. Diabet Med . 1989; 6: 12–15.
3.
Weir CJ, Murray GD, Dyker AG, Lees KR. Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of long term follow up study. AMJ . 1997; 14: 1301–1306.
4.
Toni D, Sacchetti ML, Argentino C, et al. Does hyperglycaemia play a role on the outcome of acute ischaemic stroke patients? J Neurol . 1992; 239: 382–386.
5.
Murros K, Fogelholm R, Kettunen S, Vuorela A-L, Valve J. Blood glucose, glycosylated haemoglobin, and outcome of ischemic brain infarction. J Neurol Sci . 1992; 111: 59–64.
6.
Bruno A, Biller J, Adams HP Jr, et al. Acute blood glucose level and outcome from ischemic stroke. Neurology . 1999; 52: 280–284.
7.
Venables G, Miller SA, Gibson G, Hardy J, Strong A. The effects of hyperglycaemia on changes during reperfusion following focal cerebral ischaemia in the cat. J Neurol Neurosurg Psychiatry . 1985; 48: 663–669.
8.
Chew W, Kucharczyk J, Moseley M, Derugin N, Norman D. Hyperglycemia augments ischemic brain injury: in vivo MR imaging/spectroscopic study with nicardipine in cats with occluded middle cerebral arteries. AJNR Am J Neuroradiol . 1991; 12: 603–609.
9.
Prado R, Goinsberg MD, Dietrich WD, Watson BD, Busto R. Hyperglycemia increases infarct size in collaterally perfused but not end-arterial vascular territories. J Cereb Blood Flow Metab . 1988; 8: 186–192.
10.
Voll C, Auer R. The effect of postischemic blood glucose levels on ischemic brain damage in the rat. Ann Neurol . 1988; 19: 1049–1053.
11.
Matchar DB, Divine GW, Heyman A, Feussner JR. The influence of hyperglycemia on outcome of cerebral infarction. Ann Int Med . 1992; 117: 449–456.
12.
Woo J, Lam CW, Kay R, Wong AH, Teoh R, Nicholls MG. The influence of hyperglycemia and diabetes mellitus on immediate and 3-month morbidity and mortality after acute stroke. Arch Neurol . 1990; 47: 1174–1177.
13.
Adams HP Jr, Olinger CP, Marler JR, et al. Comparison of admission serum glucose concentration with neurologic outcome in acute cerebral infarction. A study in patients given naloxone. Stroke . 1988; 19: 455–458.
14.
McDonald CJ, Overhage JM, Tierney WM, et al. The Regenstrief Medical Record System: a quarter century experience. Int J Med Inf . 1999; 54: 225–253.
15.
Benesch C, Witter DM, Wilder AL, et al. Inaccuracy of the international classification of diseases (ICD-9-CM) in identifying the diagnosis of ischemic cerebrovascular disease. Neurology . 1997; 49: 660–664.
16.
Williams LS, Yilmaz E, Lopez-Yunez AM. Retrospective assessment of initial stroke severity with the NIH Stroke Scale. Stroke . 2000; 31: 858–62.
17.
Queale WS, Seidler AJ, Brancati FL. Glycemic control and sliding scale insulin use in medical inpatients with diabetes mellitus. Arch Intern Med . 1997; 157: 545–552.
18.
Levetan CS, Passaro M, Jablonski K, Kass M, Ratner RE. Unrecognized diabetes among hospitalized patients. Diabetes Care . 1998; 21: 246–249.
19.
Robbins JM, Vaccarino V, Shang H, Kasl SV. Excess type 2 diabetes in African-American women and men aged 40–74 and socioeconomic status: evidence from the Third National Health and Nutrition Examination Survey. J Epidemiol Community Health . 2000; 54: 839–845.
20.
Sprafka JM, Virnig BA, Shahar E, McGovern PG. Trends in diabetes prevalence among stroke patients and the effect of diabetes on stroke survival: the Minnesota Heart Survey. Diabet Med . 1994; 11: 678–684.
21.
Mokdad AH, Ford ES, Bowman BA, et al. Diabetes trends in the U.S.: 1990–1998. Diabetes Care . 2000; 23: 1278–1283.
22.
Moulin T, Laurent T, Crepin-Leblond T, Chavot D, Berges S, Rumbach L. The Besancon Stroke Registry: an acute stroke registry of 2,500 consecutive patients. Eur Neurol . 1997; 38: 10–20.
23.
Jorgensen H, Nakayama H, Raaschou HO, Olsen TS. Stroke in patients with diabetes. The Copenhagen Stroke Study Stroke . 1994; 24: 1944–1984.
24.
Gray CS, Taylor R, French JM, et al. The prognostic value of stress hyperglycaemia and previously unrecognized diabetes in acute stroke. Diabet Med . 1987; 4: 237–240.
25.
Kiers L, Davis SM, Larkins R, et al. Stroke topography and outcome in relation to hyperglycaemia and diabetes. J Neurol Neurosurg Psychiatry . 1992; 55: 263–270.
26.
Cazzato G, Zorzon M, Mase G, Iona LG. Hyperglycemia at ischemic stroke onset as prognostic factor. Ital J Neurol Sci . 1991; 12: 283–288.
27.
Hooker H, Friday G, Alter M, et al. Diabetic control after an initial stroke: effect on second stroke and death. Abstract Neurology . 1992; 42 (suppl 3): 273.
28.
Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet . 2000; 355: 773–778.
29.
Tracey F, Crawford VLS, Lawson JT, Buchanan KD, Stout RW. Hyperglycaemia and mortality from acute stroke. Q J Med . 1993; 86: 439–446.
30.
Harris MI, Eastman RC, Cowie CC, Flegal KM, Eberhardt MS. Racial and ethnic differences in glycemic control of adults with type 2 diabetes. Diabetes Care . 1999; 22: 403–408.
31.
Scott JF, Robinson GM, French JM, O’Connell JE, Alberti KG, Gray CS. Glucose potassium insulin infusions in the treatment of acute stroke patients with mild to moderate hyperglycemia: the Glucose Insulin in Stroke Trial (GIST). Stroke . 1999; 30: 793–799.
32.
Malmberg K, Ryden L, Efendic S, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in deiabetic patients with acute myocardial infarction (DIGAMI Study): effects on mortality at 1 year. J Am Coll Cardiol . 1995; 26: 57–65.

Information & Authors

Information

Published In

Neurology®
Volume 59Number 1July 9, 2002
Pages: 67-71
PubMed: 12105309

Publication History

Received: September 21, 2001
Accepted: March 22, 2002
Published in print: July 9, 2002
Published online: July 2, 2023

Permissions

Request permissions for this article.

Authors

Affiliations & Disclosures

L. S. Williams, MD
From Roudebush VA Medical Center (Drs. Williams and Tierney); Department of Neurology (Drs. Williams, Espay, and Bruno), Indiana University School of Medicine; Regenstrief Institute for Health Care (Drs. Williams, Rotich, and Tierney); Department of Medicine (Drs. N. Fineberg, S. Fineberg, and Tierney, and R. Qi), Indiana University School of Medicine, Indianapolis; and Moi University Faculty for the Health Sciences (Dr. Rotich), Eldoret, Kenya.
J. Rotich, PhD
From Roudebush VA Medical Center (Drs. Williams and Tierney); Department of Neurology (Drs. Williams, Espay, and Bruno), Indiana University School of Medicine; Regenstrief Institute for Health Care (Drs. Williams, Rotich, and Tierney); Department of Medicine (Drs. N. Fineberg, S. Fineberg, and Tierney, and R. Qi), Indiana University School of Medicine, Indianapolis; and Moi University Faculty for the Health Sciences (Dr. Rotich), Eldoret, Kenya.
R. Qi, MS
From Roudebush VA Medical Center (Drs. Williams and Tierney); Department of Neurology (Drs. Williams, Espay, and Bruno), Indiana University School of Medicine; Regenstrief Institute for Health Care (Drs. Williams, Rotich, and Tierney); Department of Medicine (Drs. N. Fineberg, S. Fineberg, and Tierney, and R. Qi), Indiana University School of Medicine, Indianapolis; and Moi University Faculty for the Health Sciences (Dr. Rotich), Eldoret, Kenya.
N. Fineberg, PhD
From Roudebush VA Medical Center (Drs. Williams and Tierney); Department of Neurology (Drs. Williams, Espay, and Bruno), Indiana University School of Medicine; Regenstrief Institute for Health Care (Drs. Williams, Rotich, and Tierney); Department of Medicine (Drs. N. Fineberg, S. Fineberg, and Tierney, and R. Qi), Indiana University School of Medicine, Indianapolis; and Moi University Faculty for the Health Sciences (Dr. Rotich), Eldoret, Kenya.
A. Espay, MD
From Roudebush VA Medical Center (Drs. Williams and Tierney); Department of Neurology (Drs. Williams, Espay, and Bruno), Indiana University School of Medicine; Regenstrief Institute for Health Care (Drs. Williams, Rotich, and Tierney); Department of Medicine (Drs. N. Fineberg, S. Fineberg, and Tierney, and R. Qi), Indiana University School of Medicine, Indianapolis; and Moi University Faculty for the Health Sciences (Dr. Rotich), Eldoret, Kenya.
A. Bruno, MD
From Roudebush VA Medical Center (Drs. Williams and Tierney); Department of Neurology (Drs. Williams, Espay, and Bruno), Indiana University School of Medicine; Regenstrief Institute for Health Care (Drs. Williams, Rotich, and Tierney); Department of Medicine (Drs. N. Fineberg, S. Fineberg, and Tierney, and R. Qi), Indiana University School of Medicine, Indianapolis; and Moi University Faculty for the Health Sciences (Dr. Rotich), Eldoret, Kenya.
S. E. Fineberg, MD
From Roudebush VA Medical Center (Drs. Williams and Tierney); Department of Neurology (Drs. Williams, Espay, and Bruno), Indiana University School of Medicine; Regenstrief Institute for Health Care (Drs. Williams, Rotich, and Tierney); Department of Medicine (Drs. N. Fineberg, S. Fineberg, and Tierney, and R. Qi), Indiana University School of Medicine, Indianapolis; and Moi University Faculty for the Health Sciences (Dr. Rotich), Eldoret, Kenya.
W. R. Tierney, MD
From Roudebush VA Medical Center (Drs. Williams and Tierney); Department of Neurology (Drs. Williams, Espay, and Bruno), Indiana University School of Medicine; Regenstrief Institute for Health Care (Drs. Williams, Rotich, and Tierney); Department of Medicine (Drs. N. Fineberg, S. Fineberg, and Tierney, and R. Qi), Indiana University School of Medicine, Indianapolis; and Moi University Faculty for the Health Sciences (Dr. Rotich), Eldoret, Kenya.

Notes

Address correspondence and reprint requests to Dr. Linda S. Williams, Roudebush VAMC, HSR&D, 1481 West 10th Street, Indianapolis, IN 46202; e-mail: [email protected]

Metrics & Citations

Metrics

Citations

Download Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.

Cited By
  1. Pathogenic role of NAMPT in the perivascular regions after ischemic stroke in mice with type 2 diabetes mellitus, Experimental Neurology, 371, (114584), (2024).https://doi.org/10.1016/j.expneurol.2023.114584
    Crossref
  2. Incidence of Stress-Induced Hyperglycemia in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis, Brain Sciences, 13, 4, (556), (2023).https://doi.org/10.3390/brainsci13040556
    Crossref
  3. Twenty-eight-day in-hospital mortality prediction for elderly patients with ischemic stroke in the intensive care unit: Interpretable machine learning models, Frontiers in Public Health, 10, (2023).https://doi.org/10.3389/fpubh.2022.1086339
    Crossref
  4. Stress hyperglycemia as a modifiable predictor of futile recanalization in patients undergoing mechanical thrombectomy for acute ischemic stroke, Frontiers in Neurology, 14, (2023).https://doi.org/10.3389/fneur.2023.1170215
    Crossref
  5. Safety Issues: Use of Continuous Subcutaneous Insulin Infusion (CSM) Pumps in Hospitalized Patients, Hospital Pharmacy, 41, 10, (956-969), (2023).https://doi.org/10.1177/001857870604101008
    Crossref
  6. Diabetes mellitus and blood glucose variability increases the 30‐day readmission rate after kidney transplantation, Clinical Transplantation, (2023).https://doi.org/10.1111/ctr.15177
    Crossref
  7. Association Between Admission Hyperglycemia and Outcomes After Endovascular Treatment in Acute Basilar Artery Occlusion, Neurology and Therapy, 12, 4, (1285-1297), (2023).https://doi.org/10.1007/s40120-023-00502-8
    Crossref
  8. Diabetes and Cerebrovascular Disease, Diabetes and Cardiovascular Disease, (551-576), (2023).https://doi.org/10.1007/978-3-031-13177-6_18
    Crossref
  9. The role of hyperglycemia in the course of strokes in patients with diabetes, Diabetes Obesity Metabolic Syndrome, 6, (2022).https://doi.org/10.57105/7252-2022-6-01
    Crossref
  10. Prognostic Significance of Admission Glucose Combined with Hemoglobin A1c in Acute Ischemic Stroke Patients with Reperfusion Therapy, Brain Sciences, 12, 2, (294), (2022).https://doi.org/10.3390/brainsci12020294
    Crossref
  11. See more
Loading...

View Options

Get Access

Login options

Check if you have access through your login credentials or your institution to get full access on this article.

Personal login Institutional Login
Purchase Options

Purchase this article to get full access to it.

Purchase Access, $39 for 24hr of access

View options

Full Text

View Full Text

Full Text HTML

View Full Text HTML

Media

Figures

Other

Tables

Share

Share

Share article link

Share