Blood glucose levels during the initial 72h and 3-month functional outcomes in acute intracerebral hemorrhage: The SAMURAI–ICH study

Koga, Masatoshi; Yamagami, Hiroshi; Okuda, S.; Okada, Yasushi; Kimura, Kazumi; Shiokawa, Yoshiaki; Nakagawara, Jyoji; Furui, Eisuke; Hasegawa, Yasuhiro; Kario, Kazuomi; Arihiro, Shoji; Sato, Shigeo; Homma, Kazunari; Matsuki, Takayuki; Kinoshita, Naoto; Nagatsuka, Kazuyuki; Minematsu, Kazuo; Toyoda, Kazunori

doi:10.1016/j.jns.2015.02.018

Cited by 38 publications

(40 citation statements)

References 27 publications

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“…A large number of observational studies (21 studies, total number of patients=12 145, Table S6)2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32 have examined the association between glucose with ICH outcome with the majority (15 studies, total n=11 161) defining hyperglycemia on the basis of single glucose measurement. One notable study was the post hoc analysis of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT) II study (n=2653) 30.…”

Section: Discussionmentioning

confidence: 99%

“…Six studies (n=984)6, 7, 8, 9, 10, 11 reported results for more than single glucose measurement. Although studies by Tapia‐Perez et al10 and Koga et al11 reported an association between glucose and outcome (Table S6), these studies (n=298) derived the outcome association from a single glucose measurement, even though multiple time points were reported.…”

Section: Discussionmentioning

confidence: 99%

“…The major limitation of these studies is use of single glucose measurement not accounting for potential glucose fluctuations after ICH. Six studies (n=60–295)6, 7, 8, 9, 10, 11 have utilized multiple glucose measurements in analysis of ICH outcome with mixed results. In preclinical studies, hyperglycemia increases neuronal cell death and brain edema by enhancing breakdown of the blood–brain barrier 12, 13.…”

Section: Introductionmentioning

confidence: 99%

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Persistent Hyperglycemia Is Associated With Increased Mortality After Intracerebral Hemorrhage

Putaala

Sharma

et al. 2017

JAHA

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BackgroundHyperglycemia may be associated with worse outcome after intracerebral hemorrhage (ICH). We assessed the association of early glycemic trajectory on ICH mortality and edema growth.Methods and ResultsWe included patients from the Helsinki ICH study with glucose measurements at least once between both 0 to 24 and 24 to 72 hours from onset. Hyperglycemia was defined as blood glucose ≥8 mmol/L (144 mg/dL) based on the local threshold for treatment. Glycemic trajectory was defined on maximum values 0 to 24 and 24 to 72 hours after ICH: (1) persistent normoglycemia in both epochs; (2) late hyperglycemia (only between 24 and 72 hours); (3) early hyperglycemia (only before 24 hours); and (4) persistent hyperglycemia in both epochs. Logistic regression with known predictors of outcome estimated the association of glycemic trajectory and 6‐month mortality. A generalized linear model assessed the association of glycemic trajectory and interpolated 72‐hour edema extension distance. A total of 576 patients met eligibility criteria, of whom 214 (37.2%) had persistent normoglycemia, 44 (7.6%) late hyperglycemia, 151 (26.2%) early hyperglycemia, and 167 (29.0%) persistent hyperglycemia. Six‐month mortality was higher in the persistent (51.1%) and early (26.3%) hyperglycemia groups than the normoglycemia (19.0%) and late hyperglycemia (3.6%) groups. Persistent hyperglycemia was associated with 6‐month mortality (odds ratio 3.675, 95% CI 1.989–6.792; P<0.001). Both univariate (P=0.426) and multivariable (P=0.493) generalized linear model analyses showed no association between glycemic trajectory and 72‐hour edema extension distance.ConclusionEarly hyperglycemia after ICH is harmful if it is persistent. Strategies to achieve glycemic control after ICH may influence patient outcome and need to be assessed in clinical trials.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Persistent Hyperglycemia Is Associated With Increased Mortality After Intracerebral Hemorrhage

Putaala

Sharma

et al. 2017

JAHA

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“…Numerous studies concluded that hyperglycemia during the prestroke period [19], in the emergency department [20], on admission [13,18], or within the initial three days after admission [14,21,22] negatively affected the survival and good functional outcome in patients with ICH. However, most studies concentrated on supratentorial hemorrhage, and few investigations have addressed this topic specifically concerning CH.…”

Section: Discussionmentioning

confidence: 99%

“…Although there were conflicting results about the association of early hyperglycemia with prognosis after ICH, most researchers agreed that hyperglycemia had an deleterious effect on short-term survival and functional outcome [11–13]. Long-term mortality and outcome over 3-month follow-up were also affected in some recent reports [14,15]. A recent meta-analysis assessing the impact of hyperglycemia on mortality risk included 17 studies with a total of 6527 ICH patients and concluded that hyperglycemia significantly increases risk of both short-term mortality and long-term mortality [16].…”

Section: Introductionmentioning

confidence: 99%

Effect of Admission Hyperglycemia on 6-Month Functional Outcome in Patients with Spontaneous Cerebellar Hemorrhage

Tao

Wang

et al. 2017

Med Sci Monit

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BackgroundCerebellar hemorrhage (CH) has a quite different treatment strategy and prognostic factors compared with supratentorial intracerebral hemorrhage (ICH). The prognostic role of hyperglycemia has been discussed mainly in cases of supratentorial hemorrhage; it remains to be elucidated following CH. We aimed to determine the association of hyperglycemia on admission with 6-month functional outcome in CH patients.Material/MethodsWe retrospectively analyzed 77 patients with acute CH between September 2010 and April 2015 in West China Hospital. Blood glucose level was measured when the patients were admitted. Primary outcome was 6-month functional outcome, which could comprehensively reflect the patient’s recovery of physical and social ability after stroke and was assessed by the modified Rankin scale (mRS). Association of hyperglycemia with functional outcome was identified in logistic regression models.ResultsThere were 50 (64.9%) patients with poor functional outcomes. Patients with poor outcome were much older (P<0.001) and had a significantly higher glucose level on admission (P<0.001), a lower Glasgow Coma Scale score (P<0.001), a larger hematoma (P=0.003), and a higher incidence of intraventricular extension (P=0.002), brainstem compression (P=0.013), and hydrocephalus (P=0.023). Multivariate analysis showed that hyperglycemia (OR 1.50, 95% CI 1.07–2.08, P=0.017 when glucose level was analyzed as a continuous variable; OR 7.46, 95% CI 1.41–39.51, P=0.018 when glucose level was dichotomized by the critical threshold of 6.78 mmol/L) emerged as an independent predictor for adverse functional outcome at 6 months.ConclusionsTo the best of our knowledge, this is the first study focusing on the relationship between hyperglycemia and long-term functional outcome after CH. The study combined with previous pertinent reports definitely indicates the poor effect of hyperglycemia on both supra- and infratentorial ICH independent of hemorrhage site. Therefore, further controlled trials are urgently needed to evaluate the benefits of glucose-lowing treatment.

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Risk Factors Associated With Mortality and Neurologic Disability After Intracerebral Hemorrhage in a Racially and Ethnically Diverse Cohort

et al. 2022

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INTRODUCTION Intracerebral hemorrhage (ICH) is the most severe subtype of stroke. Its mortality rate is high, and most survivors experience significant disability. OBJECTIVE To assess primary patient risk factors associated with mortality and neurologic disability 3 months after ICH in a large, racially and ethnically balanced cohort. DESIGN, SETTING, AND PARTICIPANTS This cohort study included participants from the Ethnic/ Racial Variations of Intracerebral Hemorrhage (ERICH) study, which prospectively recruited 1000 non-Hispanic White, 1000 non-Hispanic Black, and 1000 Hispanic patients with spontaneous ICH to study the epidemiological characteristics and genomics associated with ICH. Participants included those with uniform data collection and phenotype definitions, centralized neuroimaging review, and telephone follow-up at 3 months. Analyses were completed in November 2021. EXPOSURES Patient demographic and clinical characteristics as well as hospital event and imaging variables were examined, with characteristics meeting P < .20 considered candidates for a multivariate model. Elements included in the ICH score were specifically analyzed. MAIN OUTCOMES AND MEASURES Individual characteristics were screened for association with 3-month outcome of neurologic disability or mortality, as assessed by a modified Rankin Scale (mRS) score of 4 or greater vs 3 or less under a logistic regression model. A total of 25 characteristics were tested in the final model, which minimized the Akaike information criterion. Analyses were repeated removing individuals who had withdrawal of care. RESULTS A total of 2568 patients (mean [SD] age, 62.4 [14.7] years; 1069 [41.6%] women and 1499[58.4%] men) had a 3-month outcome determination available, including death. The final logistic model had a significantly higher area under the receiver operating characteristics curve (C = 0.88) compared with ICH score alone (C = 0.76; P < .001). Among characteristics associated with neurologic disability and mortality were larger log ICH volume (OR, 2.74; 95% CI, 2.36-3.19; P < .001),

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Blood glucose levels during the initial 72h and 3-month functional outcomes in acute intracerebral hemorrhage: The SAMURAI–ICH study

Cited by 38 publications

References 27 publications

Persistent Hyperglycemia Is Associated With Increased Mortality After Intracerebral Hemorrhage

Persistent Hyperglycemia Is Associated With Increased Mortality After Intracerebral Hemorrhage

Effect of Admission Hyperglycemia on 6-Month Functional Outcome in Patients with Spontaneous Cerebellar Hemorrhage

Risk Factors Associated With Mortality and Neurologic Disability After Intracerebral Hemorrhage in a Racially and Ethnically Diverse Cohort

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