Admission Hyperglycemia and Clinical Outcome in Cerebral Venous Thrombosis

Stroke. 2016 Feb;47(2):390-6. doi: 10.1161/STROKEAHA.115.011177. Epub 2015 Dec 15.

Abstract

Background and purpose: Admission hyperglycemia is associated with poor clinical outcome in ischemic and hemorrhagic stroke. Admission hyperglycemia has not been investigated in patients with cerebral venous thrombosis.

Methods: Consecutive adult patients with cerebral venous thrombosis were included at the Academic Medical Center, The Netherlands (2000-2014) and the Helsinki University Central Hospital, Finland (1998-2014). We excluded patients with known diabetes mellitus and patients without known admission blood glucose. We defined admission hyperglycemia as blood glucose ≥7.8 mmol/L (141 mg/dL) and severe hyperglycemia as blood glucose ≥11.1 mmol/L (200 mg/dL). We used logistic regression analysis to determine if admission hyperglycemia was associated with modified Rankin Scale (mRS) score of 3 to 6 or mortality at last follow-up. We adjusted for: age, sex, coma, malignancy, infection, intracerebral hemorrhage, deep cerebral venous thrombosis, and location of recruitment.

Results: Of 380 patients with cerebral venous thrombosis, 308 were eligible. Of these, 66 (21.4%) had admission hyperglycemia with 8 (2.6%) having severe admission hyperglycemia. Coma (31.3% versus 5.0%, P<0.001) and intracerebral hemorrhage (53.0% versus 32.6%, P=0.002) at presentation were more common among patients with admission hyperglycemia than normoglycemic patients. Patients with admission hyperglycemia had a higher risk of mRS score of 3 to 6 (adjusted odds ratio, 3.10; 95% confidence interval, 1.35-7.12) and mortality (adjusted odds ratio, 4.13; 95% confidence interval, 1.41-12.09). Severe hyperglycemia was even more strongly associated with mRS score of 3 to 6 (adjusted odds ratio, 11.59; 95% confidence interval, 1.74-77.30) and mortality (adjusted odds ratio, 33.36; 95% confidence interval, 3.87-287.28) compared with normoglycemic patients.

Conclusions: Admission hyperglycemia is a strong predictor of poor clinical outcome in patients with cerebral venous thrombosis.

Keywords: coma; diabetes mellitus; hyperglycemia; risk factors; sinus thrombosis, intracranial; stroke.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anticoagulants / therapeutic use
  • Cerebral Hemorrhage / epidemiology*
  • Cerebral Hemorrhage / therapy
  • Cohort Studies
  • Coma / epidemiology*
  • Comorbidity
  • Decompressive Craniectomy
  • Female
  • Finland / epidemiology
  • Humans
  • Hyperglycemia / drug therapy
  • Hyperglycemia / epidemiology*
  • Hypoglycemic Agents / therapeutic use
  • Insulin / therapeutic use
  • Intensive Care Units / statistics & numerical data
  • Intracranial Thrombosis / epidemiology
  • Intracranial Thrombosis / mortality
  • Intracranial Thrombosis / therapy
  • Logistic Models
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Odds Ratio
  • Prognosis
  • Retrospective Studies
  • Severity of Illness Index
  • Sinus Thrombosis, Intracranial / epidemiology
  • Sinus Thrombosis, Intracranial / mortality*
  • Sinus Thrombosis, Intracranial / therapy
  • Venous Thrombosis / epidemiology
  • Venous Thrombosis / mortality*
  • Venous Thrombosis / therapy

Substances

  • Anticoagulants
  • Hypoglycemic Agents
  • Insulin