Effects of Hyperglycemia on Neurologic Outcome in Stroke Patients

Alison S. Paolino; Krista M. Garner

Disclosures

J Neurosci Nurs. 2005;37(3):130-135. 

In This Article

Hyperglycemic Effects on Neurologic Patient Outcomes

For two decades, researchers have studied the effects of hyperglycemia on clinical outcomes of patients with neurologic injury (Jeremitsky, Omert, Dunham, Protetch, & Rodriguez, 2003). Hyperglycemia associated with DM is a well-established risk factor for vascular disease. However, the effects of acute hyperglycemia on neurologic outcome, whether related to DM or in response to stress during acute illness, are not well understood.

The effect of hyperglycemia at hospital admission on stroke outcome is of great interest to the neurologic research community. Williams et al. (2002) found that in a study of 656 patients with acute ischemic stroke, those with hyperglycemia upon hospital admission had a significantly higher risk for death at 30 days, 1 year, and 6 years following stroke. They also noted that patients with admission hyperglycemia had longer hospital stays and incurred higher hospital costs. In a systematic overview of 32 studies, Capes, Hunt, Malmberg, Pathak, and Gerstein (2001) concluded that stress hyperglycemia upon hospital admission was associated with poor functional recovery. Patients with no history of DM who had an ischemic stroke and moderately elevated glucose levels also had a threefold higher risk of short-term mortality and an increased risk of poor functional recovery compared with patients with lower glucose levels.

Persistent hyperglycemia throughout hospitalization also may play an important role in poor neurologic outcomes. Baird et al. (2003) studied 25 patients who underwent serial glucose testing for 72 hours following the onset of stroke symptoms. MRI was obtained at 15 hours, 5 days, and 85 days after the onset of stroke symptoms. It was found that persistent hyperglycemia influenced stroke evolution, and was a significant indicator of infarct progression and negative clinical and functional outcomes.

Hyperglycemia also has been studied as an important outcome indicator in other types of neurologic injury. In a study of 81 patients diagnosed with traumatic brain injury, Jeremitsky et al. (2003), found that hyperglycemia was associated with increased mortality and longer hospital stays. In another study of traumatic brain-injured patients, high admission glucose levels were associated with worsened neurologic outcome (Young, Ott, Dempsey, Haack, & Tibbs, 1989).

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