Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke
Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke
复制标题
DOI：
10.1212/wnl.59.1.67
复制
发表时间：
2002-07-09
期刊：
影响因子：
9.9
通讯作者：
Tierney, WR
中科院分区：
文献类型：
--
作者：
Williams, LS;Rotich, J;Tierney, WR
背景：在人类和动物研究中，急性缺血性卒中时的高血压与不良结局有关。目的：描述急性缺血性卒中患者入院时高血糖的患病率和严重程度，检查入院时高血糖与全因死亡率的独立关系，并记录高血糖的住院管理。方法：选择1993年7月至1998年6月在某医院住院的急性缺血性脑卒中患者656例。从电子病历系统中检索人口统计学数据、诊断和血糖（BG）值。入院时严重中风，手指针刺。通过病历审查获得BG结果和新的糖尿病诊断，高血糖定义为随机血清BG大于或等于130 mg/dL。使用多变量考克斯回归模型计算30天、1年和6年死亡率的风险比（HR）。结果：40%的急性脑卒中患者入院时存在高血压。高血糖症患者多为女性，且更有可能既往诊断为糖尿病和心力衰竭。几乎所有这些患者在住院期间都保持高血糖（平均BG = 206 mg/dL），43%的患者未接受住院降血糖药物治疗。高血糖患者的住院时间较长（7天vs 6天，p = 0.015），住院费用较高（6，611美元vs 5，262美元，p < 0.001）。高血压独立增加卒中后30天（HR 1.87，p ≤ 0.01）、1年（HR 1.75，p ≤ 0.01）和6年（HR 1.41，p ≤ 0.01）的死亡风险。结论：急性缺血性卒中患者常出现高血糖，并与短期和长期死亡率增加和住院费用增加相关。该医院的住院患者血糖管理不理想。应考虑进行高血糖症强化治疗试验。
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 greater than or equal to 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 less than or equal to 0.01), 1 year (HR 1.75, p less than or equal to 0.01), and 6 years after stroke (HR 1.41, p less than or equal to 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.