Diabetic and stress‐induced hyperglycemia in spontaneous intracerebral hemorrhage: A multicenter prospective cohort (CHEERY) study

Abstract

Introduction: Admission hyperglycemia is a common finding after spontaneous intracerebral hemorrhage (ICH) secondary to pre-existing diabetes mellitus (DM) or stress-induced hyperglycemia (SIH). Studies of the causal relationship between SIH and ICH outcomes are rare. Aim: We aimed to identify whether SIH or pre-existing DM was the cause of admission hyperglycemia associated with ICH outcomes. Methods: Admission glycosylated hemoglobin (HbA1c), glucose levels, and comorbidity data from the prospective, multicenter cohort, Chinese Cerebral Hemorrhage: Mechanisms and Intervention Study (CHEERY), were collected and analyzed. According to different admission blood glucose and HbA1c levels, patients were divided into nondiabetic normoglycemia (NDN), diabetic normoglycemia (DN), diabetic hyperglycemia (DH), and SIH groups. Modified Poisson regression models were used to analyze ICH outcomes in the different groups.Results: In total, 1372 patients were included: 388 patients with admission hyperglycemia, 239 with DH, and 149 with SIH. In patients with hyperglycemia, SIH was associated with a higher risk of pulmonary infection [risk ratios (RR): 1.477, 95% confidence interval (CI): 1.004-2.172], 30-day (RR: 1.068, 95% CI: 1.009-1.130) and 90day mortality after ICH (RR: 1.060, 95% CI: 1.000-1.124).Conclusions: Admission hyperglycemia is a common finding after ICH, and SIH is a sensitive predictor of the risk of pulmonary infection and all-cause death after ICH.

Prognostic significance of the stress hyperglycemia ratio and admission blood glucose in diabetic and nondiabetic patients with spontaneous intracerebral hemorrhage

“…More importantly, we proved that SHR, as a continuous variable, was independently related to the 30-day and 1-year mortality in ICH patients with diabetes, but that was not the case for ABG. This result was similar to a recent study derived from the Chinese Cerebral Hemorrhage: Mechanisms and Intervention Study (CHEERY) [ 25 ]. In this study, Chen et al divided ICH patients into nondiabetic normoglycemia (NDN), diabetic normoglycemia (DN), diabetic hyperglycemia (DH), and stress-induced hyperglycemia (SIH) groups, and found that compared with patients with NDN, DH did not increase the risk of poor outcome and mortality, whereas SIH was an independent risk factor for pulmonary infection and 30- and 90-day death after ICH [ 25 ].…”

“…This result was similar to a recent study derived from the Chinese Cerebral Hemorrhage: Mechanisms and Intervention Study (CHEERY) [ 25 ]. In this study, Chen et al divided ICH patients into nondiabetic normoglycemia (NDN), diabetic normoglycemia (DN), diabetic hyperglycemia (DH), and stress-induced hyperglycemia (SIH) groups, and found that compared with patients with NDN, DH did not increase the risk of poor outcome and mortality, whereas SIH was an independent risk factor for pulmonary infection and 30- and 90-day death after ICH [ 25 ]. Although Chen et al defined stress hyperglycemia by other method (having a diabetes history or HbA1c ≥ 6.5%, and admission blood glucose ≥ 7.8 mmol/L) [ 26 ] instead of SHR, the results from their study and ours indicated that stress hyperglycemia may be more closely associated with adverse prognosis in diabetic patients with ICH than admission hyperglycemia.…”

Autonomic dysfunction and treatment strategies in intracerebral hemorrhage

“…[99][100][101] Stress hyperglycemia has also been reported to be associated with early hematoma enlargement and perihematomal edema aggravation in patients with ICH. 98,[101][102][103][104] Post-stroke stress hyperglycemia has been supposed to be associated with increased sympathetic activity and secretion of cortisol and norepinephrine, contributing to increased hepatic glucose output and insulin resistance. 105,106 Sykora et al demonstrated an association between stress hyperglycemia and decreased BRS in non-diabetic patients, which indicated that post-stroke hyperglycemia may be the result of autonomic shift toward sympathetic hyperactivity.…”

“…Stress hyperglycemia secondary to acute stroke, usually assessed by stress hyperglycemia ratio, is characterized by transient hyperglycemia, and has been indicated to better predict mortality, poor neurological outcome, and infectious complications 99–101 . Stress hyperglycemia has also been reported to be associated with early hematoma enlargement and perihematomal edema aggravation in patients with ICH 98,101–104 …”

“…Hyperglycemia occurs frequently in patients with acute stroke, which has been indicated to be associated with poor functional outcome and mortality in both diabetic and non‐diabetic patients. 96 , 97 , 98 Stress hyperglycemia secondary to acute stroke, usually assessed by stress hyperglycemia ratio, is characterized by transient hyperglycemia, and has been indicated to better predict mortality, poor neurological outcome, and infectious complications. 99 , 100 , 101 Stress hyperglycemia has also been reported to be associated with early hematoma enlargement and perihematomal edema aggravation in patients with ICH.…”