The influence of diabetes and hyperglycemia on clinical course after intracerebral hemorrhage

Passero, S.; Ciacci, G.; Ulivelli, Monica

doi:10.1212/01.wnl.0000094326.30791.2d

Cited by 189 publications

(135 citation statements)

References 24 publications

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“…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%

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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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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

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“…Experimental studies indicate that hyperglycaemia may increase brain oedema [12], inflammatory reaction [13], free radical injury [14] and excitotoxic or apoptotic cell death after stroke [15], but these results have not yet been demonstrated in humans to our knowledge. Although several studies have described possible effects of hyperglycaemia in ICH patients [4,5,[16][17][18][19][20][21], these studies used either small populations [5,16,17,19] or long enrolment periods [4]. Two small prospective studies [17,22] showed that hyperglycaemia is independently associated with shortterm mortality.…”

Section: Discussionmentioning

confidence: 99%

“…However, few studies have addressed this topic with regard to haemorrhagic stroke and no consensus has been established on the associated risks. A prospective study conducted in a single Italian centre indicated that hyperglycaemia is an independent predictor of 3 day and 3 month mortality in non-diabetic, non-comatose patients after supratentorial intracerebral haemorrhage (ICH) [4]. In contrast, a population-based retrospective study conducted in Finland suggested that high admission blood glucose is the result of serious ICH [5].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2009

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Aims/hypothesis Admission hyperglycaemia is associated with a poor outcome in patients with ischaemic stroke. However, its prognostic effects after intracerebral haemorrhage (ICH) are still unclear. Methods We prospectively enrolled patients with ICH at 33 centres in Korea between October 2002 and March 2004. A total of 1,387 patients who had ICH and underwent brain computed tomography within 48 h of symptom onset were included in the study (n=1,387). Clinical information and radiological findings were collected at admission. Glucose levels were examined in relation to early (up to 30 days after ictus) and long-term (after 30 days) mortality rates using Cox regression analysis. To eliminate short-term effects, long-term mortality rate analysis was performed on surviving patients for more than 30 days. Results The long-term mortality rate was 21.1% after a mean follow-up of 434.3±223.2 days and was found to increase significantly with glucose quartile (p<0.001). Admission glucose level was an independent risk factor for early mortality (per mmol/l; adjusted HR 1.10 [95% CI 1.01-1.19]), but not for long-term mortality. Moreover, when analysis was restricted to patients without diabetes, glucose level was found to be an independent risk factor for post-ICH mortality (n=1,119; adjusted HR 1.10 [95% CI 1.03-1.17]) and had marginal significance for early (p= 0.053) and long-term mortality (p=0.09). Conclusions/interpretation We found that admission glucose levels were associated with early mortality after ICH. In patients without diabetes, admission glucose levels were associated with long-term mortality. We therefore suggest that intensive lowering of glucose level should be further investigated in ICH patients.

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“…This independently predicts higher mortality rates in patients with and without diabetes [86,87]. In addition, hyperglycemia is associated with larger hematoma volumes and more intraventricular hemorrhage (IVH) [86,87].…”

Section: Supportive Carementioning

confidence: 99%

Therapeutic Strategies in Acute Intracerebral Hemorrhage

Brouwers

Goldstein

2012

Neurotherapeutics

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The influence of diabetes and hyperglycemia on clinical course after intracerebral hemorrhage

Cited by 189 publications

References 24 publications

Persistent Hyperglycemia Is Associated With Increased Mortality After Intracerebral Hemorrhage

Persistent Hyperglycemia Is Associated With Increased Mortality After Intracerebral Hemorrhage

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

Therapeutic Strategies in Acute Intracerebral Hemorrhage

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