Introduction: Nearly 40% of stroke patients present with hyperglycemia, yet little is known about the mechanism by which hyperglycemia affects hemorrhagic transformation (HT) and functional outcome in diabetics as compared to non-diabetics.
Methods: We performed a retrospective review of consecutive ischemic stroke patients presenting to our comprehensive stroke center (CSC) from March 2014 to April 2015. Demographic, clinical, and neuroimaging data were collected. Patients were divided into four groups: (1) no type II diabetes (DM) with glucose on admission <180 [reference group], (2) No DM with glucose >180, (3) DM with glucose <180, and (4) DM with glucose >180. Hemorrhagic transformation (HT) and poor functional outcome at discharge, as measured by modified Rankin scale (mRS) score 3-6, were compared amongst groups.
Results: A total of 773 consecutive patients were admitted during the 14-month period (mean age 64, 49.3% women, and 36.6% Black). When compared to the reference group (n=467), patients without DM, but with glucose >180 (n=50) had higher odds of developing HT (OR 10.6, 95%CI 5.47-20.4, p<0.0001). This association persisted even after adjusting for age, stroke severity, IV tPA use, and endovascular therapy (NIHSS, OR 3.65, 95%CI 1.34-9.97, p=0.011). When compared to the reference group (n=467), patients with DM and glucose >180 (n=104) had higher odds of poor functional outcome even after adjusting for age, stroke severity, IV tPA use, and endovascular therapy (NIHSS, OR 1.88, CI 1.04-3.42, p=0.037).
Conclusions: We observed that hyperglycemia on admission was associated with HT in non-diabetics and associated with poor functional outcome in diabetics. Reasons that diabetics with hyperglycemia do not experience HT remain unclear. A better understanding of the pathophysiology of acute hyperglycemia in patients with and without DM is needed in order to minimize the risk of HT and its adverse effects.