Early hyperglycaemia and the early‐term death in patients with spontaneous intracerebral haemorrhage: a meta‐analysis

Tan, Xuerui; He, Jia; Li, L.; Gao, Yang; Liu, H.; Tang, Sisi; Wang, Y.

doi:10.1111/imj.12352

Cited by 21 publications

(24 citation statements)

References 25 publications

(26 reference statements)

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“…High blood glucose values have shown a strong association with higher mortality and morbidity in multiple cohorts, independent to the presence of Diabetes Mellitus (9, 14, 15, 17, 32, 33), while some others (8, 12, 23) have shown contrasting reports like ours. Two Meta-analysis have concluded that hyperglycaemia increases both short term and long term mortality in intracerebral hemorrhage (15, 16).…”

Section: Discussionsupporting

confidence: 39%

Influence of Admission Blood Glucose in Predicting Outcome in Patients With Spontaneous Intracerebral Hematoma

et al. 2018

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Background and Aims: Hyperglycemia or elevated blood glucose levels have been associated with poor outcomes in patients with ischemic stroke yet control of hyperglycemia has not resulted in good outcomes. High admission blood glucose (ABG) values have been mitigated by other poor prognosticators like large hematoma volume, intraventricular extension (IVE) of hematoma and poor GCS. The aim of this study was to evaluate the effects of blood glucose levels at admission, on mortality and functional outcomes at discharge and 3 months follow up.Methods: This was a retrospective observational study conducted at a tertiary care. Patients with spontaneous SICH were enrolled from a prospective SICH register maintained at our hospital. Blood glucose values were recorded on admission. Patients with traumatic hematomas, vascular malformations, aneurysms, and coagulation abnormalities were excluded from our study.Results: A total of 510 patients were included in the study. We dichotomised our cohort into two groups, group A with ABG>160 mg/dl and group B with ABG<160 mg/dl. Mean blood glucose levels in these two groups were 220.73 mg/dl and 124.37 mg/dl respectively, with group A having twice the mortality. mRS at discharge and 3 months was better in Group B (p ≤ 0.001) as compared to Group A. Age, GCS, volume of hematoma, ABG, IVE and Hydrocephalus were significant predictors of mortality and poor outcome on univariate analysis with a p < 0.05. The relationship between ABG and mortality (P = 0.249, 95% CI 0.948–1.006) and outcome (P = 0.538, 95% CI 0.997–1.005) failed to reach statistical significance on multivariate logistic regression. Age, Volume of hematoma and GCS were stronger predictors of mortality and morbidity.Conclusion: Admission blood glucose levels was not an independent predictor of mortality in our study when adjusted with age, GCS, and hematoma volume. The effect of high ABG on SICH outcome is probably multifactorial and warrants further research.

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Section: Discussionsupporting

confidence: 39%

Influence of Admission Blood Glucose in Predicting Outcome in Patients With Spontaneous Intracerebral Hematoma

et al. 2018

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“…Generally, a long duration of hyperglycemia induces edema around the hematoma, causing expansion of cell damage, which leads to the production of more cortisol in intracerebral hemorrhage,5, 33, 34 and it is accordingly associated with unfavorable outcomes 35, 36, 37. Thus, the negative findings in the present study might be attributed to the small sample size.…”

Section: Discussionmentioning

confidence: 60%

Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring

Wada

Yoshimura

Inoue

et al. 2018

JAHA

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BackgroundThe purpose of this study was to examine the relationships between glucose parameters obtained by continuous glucose monitoring and clinical outcomes in acute stroke patients.Methods and ResultsConsecutive patients with acute ischemic stroke or intracerebral hemorrhage within 24 hours after onset were included. A continuous glucose monitoring device (iPro2) was attached for the initial 72 hours after emergent admission. Eight glucose parameters were obtained from continuous glucose monitoring: maximum, minimum, mean, and SD of blood glucose levels, as well as area under the curve more than 8 mmol/L of blood glucose, distribution time more than 8 mmol/L of blood glucose, coefficient of variation (%CV), and presence of time less than 4 mmol/L over 72 hours. The primary outcome measure was death or dependency at 3 months (modified Rankin Scale score ≥3). One hundred patients with acute ischemic stroke (n=58) or intracerebral hemorrhage (n=42) were included. Blood glucose levels varied between 5.2±1.4 and 11.4±3.2 mmol/L over 72 hours, with area under the curve more than 8 mmol/L of blood glucose of 0.7±1.4 min×mmol/L, distribution time more than 8 mmol/L of blood glucose of 31.7±32.7%, coefficient of variation of 15.5±5.4%, and presence of hypoglycemia in 20% of overall patients. Mean glucose level (adjusted odds ratio, 1.60, 95% confidence interval, 1.12–2.28/1 mmol/L), area under the curve more than 8 mmol/L of blood glucose (2.13, 1.12–4.02/1 min×mmol/L), and distribution time more than 8 mmol/L of blood glucose (1.25, 1.05–1.50/10%) were related to death or dependency for overall patients, as well as for acute ischemic stroke patients (2.05, 1.15–3.65; 2.38, 1.04–5.44; 1.85, 1.10–3.10, respectively).ConclusionsHigh mean glucose levels, distribution time more than 8 mmol/L of blood glucose, and areas under the curve more than 8 mmol/L of blood glucose during the initial 72 hours of acute stroke were associated with death or dependency at 3 months.

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“…Qureshi et al analyzed the association of change in blood glucose level within 72 h after admission and poor 3-month outcome (judged as mRS [4][5][6] in the Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) cohort, which consisted of a total of 60 patients with acute ICH [8]. They found that an increasing serum glucose level was significantly associated with hematoma expansion and poor clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Elevated blood glucose on admission is a well-known predictor of hematoma expansion [1,2], perihematomal edema [3] and death [4][5][6] in patients with intracerebral hemorrhage (ICH). In a recent study, history of diabetes represented an independent predictor of death by 3 months after ICH onset, whereas high blood glucose level on admission did not [7].…”

Section: Introductionmentioning

confidence: 99%

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

Koga

Yamagami

Okuda

et al. 2015

Journal of the Neurological Sciences

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Early hyperglycaemia and the early‐term death in patients with spontaneous intracerebral haemorrhage: a meta‐analysis

Abstract: Early hyperglycaemia can significantly increase the rate of early-term death in patients with sICH, independent of the cut-off points for hyperglycaemia.

Cited by 21 publications

References 25 publications

Influence of Admission Blood Glucose in Predicting Outcome in Patients With Spontaneous Intracerebral Hematoma

Influence of Admission Blood Glucose in Predicting Outcome in Patients With Spontaneous Intracerebral Hematoma

Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring

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

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