Persistent Hyperglycemia Is Associated With Increased Mortality After Intracerebral Hemorrhage

Abstract

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.

Osteopontin attenuates inflammation via JAK2/STAT1 pathway in hyperglycemic rats after intracerebral hemorrhage

“…The acute hyperglycemia is common for the patients with preexisting diabetes. After ICH, however, more than 59% of patients without diabetes show increase blood glucose concentration on admission, and blood glucose level remains upregulated till 72 h after admission in 45% of patients (Bejot et al, 2012; Godoy et al, 2008; Wu et al, 2017). The high level of glucose is a predisposition for worth neurological outcomes, poor functional recovery at discharge and increased 1-month mortality after ICH (Bejot et al, 2012; Godoy et al, 2008).…”

17p12 Influences Hematoma Volume and Outcome in Spontaneous Intracerebral Hemorrhage

“…We chose this approach given the known differences in biology across locations 29 , which were confirmed by a previous GWAS of ICH risk 11 . Following standard practices in the field, ICH volume was natural log-transformed to approximate normality 30–32 . Analyses were computed separately for the discovery and replication phases via linear regression, assuming additive genetic effects (1-degree-of-freedom additive trend test) and adjusting for age, sex, and the first four principal components.…”

Oedema extension distance in intracerebral haemorrhage: Association with baseline characteristics and long-term outcome

“…[7][8][9] We have recently described a novel parameter, the oedema extension distance (EED), which has been employed by other groups. 10,11 It is relatively less dependent on haematoma volume and may reduce the sample size required in proof-of-concept trials by around 75% when compared to absolute or relative PHE volume. 12 Understanding the baseline determinants of EED and its association with clinical outcomes is required to establish the utility of EED as a surrogate outcome measure in ICH clinical trials.…”