Association of pre- and post-stroke glycemic status with clinical outcome in spontaneous intracerebral hemorrhage

Abstract

In this study, we aimed to disclose the association of pre- and post-stroke glycemic status with clinical outcome in patients with spontaneous intracerebral hemorrhage (sICH). It was a multicenter, prospective, observational cohort study, conducted in 13 hospitals in Beijing from January 2014 to September 2016. The association of admission random blood glucose (RBG), fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) with clinical outcome at 90 days after sICH onset were analyzed comprehensively. Poor outcome was defined as death or modified Rankin Scale (mRS) score >2. The results showed that elevated RBG and FBG were associated with larger hematoma volume, lower GCS, higher NIHSS (P < 0.001), and poor outcome, but HbA1c was not (P > 0.05). In stratified analysis, the association of poor outcome with elevated FBG or RBG retained statistical significance just in patients without diabetes. Kaplan-Meier curve and Cox regression showed that patients with elevated FBG or RBG had significantly higher risk of death within 90 days (P < 0.05). So we conclude that poststroke hyperglycemia was associated with larger hematoma volume, severe neurological damage and poor clinical outcome, but HbA1c was not relevant to hematoma volume or clinical outcome in patients with sICH.

Predictive Relevance of Baseline Lactate and Glucose Levels in Patients with Spontaneous Deep-Seated Intracerebral Hemorrhage

“…In an animal experimental approach with induced hyperglycemia, Song et al found it to result in more severe brain edema and perihematomal cell death [22]. Similarly, studies in the clinical setting-consistent with the present study-demonstrated that patients with elevated blood glucose on admission had significantly higher mortality at 90 days, regardless of preexisting glycemic status prior to hemorrhage [23]. The data of the present study also indicate, within patients with deep-seated ICH, that not only the presence of hyperglycemia on admission but also an excessive peak value occurring within the first days after hemorrhage seems to be associated with a lower probability of survival at 90 days.…”

Relationship Between Glycosylated Hemoglobin and Short-Term Mortality of Spontaneous Intracerebral Hemorrhage

“…Taken together, HbA1c levels might affect the incidence and prognosis of an acute cerebral hemorrhage, which is consistent with our findings. However, our outcome is contrary to a previous study showing that HbA1c was not associated with clinical outcome in patients with SICH (28).…”

“…Some studies revealed that HbA1c is a better predictor of adverse outcomes in patients with SICH (25)(26)(27). However, a study showed that HbA1c is not associated with clinical outcome in patients with SICH (28). The relationship between HbA1c and the prognosis of SICH patients is not yet fully elucidated.…”

Serum glucose and potassium ratio as a predictive factor for prognosis of acute intracerebral hemorrhage

“…Some studies have suggested that post-stroke hyperglycemia may arise from a stress reaction, and the major glucose-regulatory hormones involved in the hyperglycemic response include catecholamines, glucagon, and corticosteroids. [25][26][27] Catecholamines are of paramount importance following injury and stress because they increase glucagon secretion, thereby elevating blood glucose concentrations. 28 Potassium, which is stored mostly within cells, is transported by active cellular uptake through the cell membrane and by the sodium/potassium adenosine triphosphatase pump (Na þ /K þ -ATPase).…”