UCONN Emergency Medicine Interest Group

Posts Tagged ‘prognosis’

Journal Article Synopsis: Is ED Hyperglycemia a Poor Prognostic Marker in Intracerebral Hemorrhage?

In JOURNAL CLUB on July 11, 2011 at 3:21 PM

Summary of “Emergency Department Hyperglycemia as a Predictor of Early Mortality and Worse Functional Outcome after Intracerebral Hemorrhage” By Latha G Stead et al, Neurocritical Care vol 13: pp. 67-74. 2010.

What is already known on this topic:
Hyperglycemia upon admission was already known to be a predictor for poor outcome in ischemic stroke. A relationship between hyperglycemia and mortality in intracerebral hemorrhage (ICH) had been suggested, but little data was present to define its prognostic ability.

What question this study addressed:
Is hyperglycemia at arrival associated with early mortality and functional outcome in patients with non-traumatic ICH?

What was the study design:
A prospective, cohort study of 237 adults presenting to the ED with CT confirmed, spontaneous ICH between 1/06 to 12/08, with a blood glucose measurement at presentation. Data was collected by two independent, blinded abstractors.

What this study adds to our knowledge:
This study showed that hyperglycemia (defined as blood glucose of ≥140) in both diabetic and non-diabetic patients is a prognostic predictor of higher mortality within 7 days. Among non-diabetics, it is also a predictor of poor clinical outcome  when controlled for stroke severity, age, and volume of hemorrhage. Furthermore, higher blood glucose values correlated with more severe stroke, measured by the NIH Stroke Scale. There was no significant difference shown among diabetic patients when glucose levels were used as a predictor for poor clinical outcome or stroke severity.

How is this relevant to clinical practice:
This study allows confirms that hyperglycemia is a red flag among patients presenting to the Emergency Department with ICH and gives clinicians an early, easily obtained prognostic indicator for mortality and outcome in these patients.

Other considerations:
Further research can be done to see if control of hyperglycemia may lead to better outcomes among ICH patients. This study is limited in its design- it only considered outcome at the end of the hospital stay, but did not control for the length of stay. More research should be done to determine if there is a difference in outcome at  specific time points over a greater length of time (eg. 3, 6, and 12 months).

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