Emergency Department Hyperglycemia as a Predictor of Early Mortality and Worse Functional Outcome after Intracerebral Hemorrhage

Ganti, Latha; Jain, Anunaya; Bellolio, M. Fernanda; Odufuye, A.O.; Gilmore, R.M.; Rabinstein, Alejandro A.; Chandra, Ramesh; Dhillon, R.K.; Manivannan, Veena; Serrano, Luis A.; Yerragondu, N.; Palamari, B.; Jain, Minal; Decker, Wyatt W.

doi:10.1007/s12028-010-9355-0

Cited by 78 publications

(65 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

See 1 more Smart Citation

Persistent Hyperglycemia Is Associated With Increased Mortality After Intracerebral Hemorrhage

Putaala

Sharma

et al. 2017

JAHA

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

“…The recommendation was based on association of hyperglycemia and poor outcome in observational studies 2, 3, 4, 5. The major limitation of these studies is use of single glucose measurement not accounting for potential glucose fluctuations after ICH.…”

Section: Introductionmentioning

confidence: 99%

Persistent Hyperglycemia Is Associated With Increased Mortality After Intracerebral Hemorrhage

Putaala

Sharma

et al. 2017

JAHA

View full text Add to dashboard Cite

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

“…[1][2][3][4][5] ICH is thought to cause hyperglycemia through an indirect, neuroendocrine stress-mediated mechanism. 6 Excessive systemic and local glucose levels exacerbate secondary cerebral injuries through metabolic dysregulation, cytotoxicity, and neuronal death.…”

mentioning

confidence: 99%

Severity of Intraventricular Extension Correlates With Level of Admission Glucose After Intracerebral Hemorrhage

Appelboom

Piazza

Hwang

et al. 2011

Stroke

View full text Add to dashboard Cite

Background and Purpose-Hyperglycemia after spontaneous intracerebral hemorrhage (ICH) is associated with poor outcome, but the pathophysiology of ICH-induced glucose dysregulation remains unclear. We sought to identify clinical and radiographic parameters of ICH that are associated with admission hyperglycemia. Methods-Patients admitted to the Columbia University Medical Center Neurological Intensive Care Unit with spontaneous ICH between January 2009 and September 2010 were prospectively enrolled in the ICH Outcomes Project. Clinical, radiographic, and laboratory data were collected prospectively. Receiver operating characteristic analysis was used to identify the glucose level with optimal sensitivity and specificity for in-hospital mortality. Logistic and linear regression analyses were used to identify independent predictors of outcome measures where appropriate. Results-One hundred four patients admitted during the study period were included in the analysis.

show abstract

Emergency Department Hyperglycemia as a Predictor of Early Mortality and Worse Functional Outcome after Intracerebral Hemorrhage

Abstract: Hyperglycemia on presentation in non-diabetic patients is an independent predictor of early mortality and worse functional outcome in patients with intracerebral hemorrhage.

Cited by 78 publications

References 37 publications

Persistent Hyperglycemia Is Associated With Increased Mortality After 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

Severity of Intraventricular Extension Correlates With Level of Admission Glucose After Intracerebral Hemorrhage

Contact Info

Product

Resources

About