Effects of glucose level on early and long-term mortality after intracerebral haemorrhage: the Acute Brain Bleeding Analysis Study

Lee, S.-H.; Kim, Beom Joon; Bae, Hee Joon; Lee, J. S.; Lee, J.; Park, Byung Joo; Yoon, Byung Woo

doi:10.1007/s00125-009-1617-z

Cited by 66 publications

(49 citation statements)

References 25 publications

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“…Our findings extend previous reports of elevated blood glucose being a predictor of adverse outcomes in ICH 8,9,13,14 ; in particular, the finding of a trend toward greater mortality from hyperglycemia that was observed in Korean multicenter study 9 of 1387 ICH patients, but not with that seen in a smaller Finnish study. 13 Sensitivity analysis of outcomes based on diagnostic thresholds (reference group <6.1 mmol/L) of blood glucose rather than fourths (reference group of 2.6-5.6 mmol/L) potentially allowed more clinically relevant glucose levels to be assessed.…”

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confidence: 89%

“…9 Animal models have shown that elevated blood pressure (BP) exacerbates cerebral injury after ICH 10 and of an association between hyperglycemia and cerebral edema. There may be a supra-additive effect of hyperglycemia and Background and Purpose-We aimed to determine associations of baseline blood glucose and diabetes mellitus with clinical outcomes in participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2).…”

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confidence: 99%

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Prognostic Significance of Hyperglycemia in Acute Intracerebral Hemorrhage

Saxena

Anderson

Wang

et al. 2016

Stroke

114

109

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A cute intracerebral hemorrhage (ICH) is the most serious and least treatable form of acute stroke 1 for which established prognostic factors include clinical severity and location and volume of hematoma at presentation.2 Although stress hyperglycemia is associated with adverse outcomes in many medical conditions, including acute ischemic stroke, 3,4 traumatic brain injury, 5 and acute myocardial infarction, 6 evidence specifically related to the critical condition of ICH is varied and conflicting because of previous studies being limited to small single-center series 7,8 with short duration of follow-up. 9 Animal models have shown that elevated blood pressure (BP) exacerbates cerebral injury after ICH 10 and of an association between hyperglycemia and cerebral edema. There may be a supra-additive effect of hyperglycemia and Background and Purpose-We aimed to determine associations of baseline blood glucose and diabetes mellitus with clinical outcomes in participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). Methods-INTERACT2 was an international prospective, open, blinded end point, randomized controlled trial of 2839 patients with spontaneous intracerebral hemorrhage (<6 hours) and elevated systolic blood pressure randomly assigned to intensive (target systolic blood pressure <140 mm Hg) or guideline-based (systolic blood pressure <180 mm Hg) BP management. Associations of hyperglycemia at presentation (>6.5 mmol/L) and combined and separate poor outcomes of death and major disability (scores of 3-6, 3-5, and 6, respectively, on the modified Rankin scale) at 90 days were determined in logistic regression models. Results-In 2653 patients with available data, there were 1348 (61%) with hyperglycemia and 292 (11%) with diabetes mellitus. Associations of baseline blood glucose and poor outcome were strong and near continuous. After adjustment for baseline variables, the highest fourth (7.9-25.0 mmol/L) of blood glucose was significantly associated with combined poor outcome (adjusted odds ratio 1. Materials and MethodsINTERACT2 was an international, multicenter, prospective, openlabel, assessor-blinded end point, randomized controlled trial, the details of which are described elsewhere. 11 In brief, 2839 patients with computed tomography-confirmed spontaneous ICH within 6 hours of onset and elevated systolic BP (150-220 mm Hg) were randomly assigned to receive intensive (target systolic BP <140 mm Hg within 1 hour) or guideline-recommended (target systolic BP <180 mm Hg) BP-lowering therapy using locally available agents according to standardized protocols. The study protocol was approved by the appropriate ethics committee at each participating site, and written informed consent was obtained from the patient or an appropriate surrogate.Demographic and clinical characteristics recorded at the time of enrollment included a history of diabetes mellitus and level of blood glucose. Stroke severity was measured using the Glasgow coma scale and National Institutes of He...

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confidence: 89%

mentioning

confidence: 99%

Prognostic Significance of Hyperglycemia in Acute Intracerebral Hemorrhage

Saxena

Anderson

Wang

et al. 2016

Stroke

114

109

View full text Add to dashboard Cite

show abstract

“…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%

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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“…Diabetes mellitus and hyperglycemia are associated with a worse prognosis of ICH 27,28 and an increased rate of hemorrhagic transformation after systemic thrombolysis in patients with ischemic stroke. 29,30 Although direct influences on the coagulation system may at least partially explain the increased bleeding risk, 31 several studies showed that macrophage responses critical for wound healing are also impaired in diabetes mellitus.…”

Section: Strokementioning

confidence: 99%

Secondary Intracerebral Hemorrhage Due to Early Initiation of Oral Anticoagulation After Ischemic Stroke

Gliem

Hermsen

Rooijen

et al. 2012

Stroke

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Background and Purpose-The uncertain risk of secondary intracerebral hemorrhage (sICH) frequently keeps clinicians from initiating oral anticoagulation (OAC) early after ischemic cardioembolic stroke. The goal of this experimental study was to determine the risk of sICH depending on the timing of OAC initiation relative to stroke onset and to address the role of hematogenous macrophages for repair processes preventing OAC-associated sICH. Methods-C57BL/6 mice were subjected to transient middle cerebral artery occlusion. Subgroups were treated with either the vitamin K antagonist (VKA) phenprocoumon or the direct thrombin inhibitor dabigatran etexilate. Hematogenous macrophages were depleted using intraperitoneal injections of clodronate-filled liposomes. Results-Time to therapeutic OAC was 48 hours with VKA and 0.5 hours with dabigatran etexilate treatment. In VKAtreated mice, the risk of sICH was high if effective OAC was already present at stroke onset or achieved within 48 hours after ischemia. With more delayed OAC, the risk of sICH rapidly decreased. Compared with VKA treatment, effective anticoagulation with dabigatran etexilate was associated with a significantly reduced extent of sICH, either if present at stroke onset or if achieved 48 hours later. Partial depletion of macrophages greatly increased the extent of OACassociated sICH in the subacute stage of 3 to 4 days after ischemia. Conclusions-Our findings suggest that repair mechanisms involving hematogenous macrophages rapidly decrease the risk of OAC-associated sICH in the first days after ischemic stroke.

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Effects of glucose level on early and long-term mortality after intracerebral haemorrhage: the Acute Brain Bleeding Analysis Study

Cited by 66 publications

References 25 publications

Prognostic Significance of Hyperglycemia in Acute Intracerebral Hemorrhage

Prognostic Significance of Hyperglycemia in Acute Intracerebral Hemorrhage

Persistent Hyperglycemia Is Associated With Increased Mortality After Intracerebral Hemorrhage

Secondary Intracerebral Hemorrhage Due to Early Initiation of Oral Anticoagulation After Ischemic Stroke

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