This study aimed to investigate the correlation between blood glucose variability and the risk of death in patients with severe acute stroke. One hundred and fifty-eight patients diagnosed with severe acute stroke were divided into survival group and death group and were retrospectively analyzed. The baseline National Institutes of Health Stroke Scale (NIHSS) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score, mean blood glucose, blood glucose standard deviation, mean amplitude of glycemic excursion, and mean variation coefficient of blood glucose were obtained and compared. Single-factor binary logistic regression analysis was used to determine the predictors of death in patients with severe acute stroke. The baseline NIHSS score (P < 0.001), APACHE II score (P < 0.001), blood glucose standard deviation (P < 0.001), mean amplitude of glycemic excursion (P < 0.001) and mean coefficient of variation of blood glucose (P < 0.001), between the survival group and the death group significant difference. The results showed that baseline NIHSS score (OR, 1.08; 95% CI, 1.03 to 1.13, P = 0.004), blood glucose standard deviation (OR, 1.14; 95% CI, 1.02 to 1.28, P = 0.028), mean amplitude of glycemic excursion (OR, 1.38; 95% CI, 1.04 to 1.83, P = 0.027), mean coefficient of variation of blood glucose (OR, 0.94; 95% CI, 0.73 to 1.21, P = 0.03), are related to the death within 3 months in patients with severe acute stroke. The blood glucose variability is an independent predictor of death in patients with severe acute stroke. Great range of glycemic excursion indicates poor disease outcome. In contrast, the mean blood glucose level does not have significant correlation with the outcomes of patients. (C) 2019 Elsevier Masson SAS. All rights reserved.