Persistent Hyperglycemia increases death risk in Non-Diabetics with Intracerebral Hemorrhage

The report from a National Institute of Neurological Disorders and Stroke Workshop on priorities for clinical research in intracerebral hemorrhage (ICH) in December 2003 recommended clinical trials for evaluation of blood pressure (BP) management in acute ICH as a leading priority. The Special Writing Group of the Stroke Council of the American Heart Association in 1999 and 2007 emphasized the need for clinical trials to ensure evidence-based treatment of acute hypertension in ICH. Therefore, Dr Iryna Lobanova and her team conducted a 5 years study to evaluate the effect of persistent hyperglycemia on outcomes in 1000 patients with intracerebral hemorrhage enrolled within 4.5 hours of symptom onset.

In this five-year international, multicenter, open-labelled, randomized study, the researchers determined moderate and severe hyperglycemia based on serum glucose levels ≥140 mg/dL—<180 and ≥180p mg/dL, respectively, measured at baseline, 24, 48, and 72 hours. They further determined persistent hyperglycemia as 2 consecutive (24 hours apart) serum glucose levels. They evaluated the relationship between moderate and severe hyperglycemia and death or disability (defined by modified Rankin Scale score of 4–6) at 90 days in the overall cohort and in groups defined by preexisting diabetes.

Key findings of the study:

• Upon multivariate analysis, the researchers found that both moderate (odds ratio, 1.8) and severe (odds ratio, 1.8) hyperglycemia were associated with higher 90-day death or disability after adjusting for Glasgow Coma Scale score, hematoma volume, presence or absence of intraventricular hemorrhage, hyperlipidemia, cigarette smoking, and hypertension.
• Among the patients without preexisting diabetes, they noted that both moderate (odds ratio, 1.8) and severe (odds ratio, 2.0) hyperglycemia were associated with 90-day death or disability after adjusting for above mentioned potential confounders.
• However, they found that the patients with preexisting diabetes, moderate and severe hyperglycemia were not associated with 90-day death or disability.

The authors concluded, "Persistent hyperglycemia, either moderate or severe, increased the risk of death or disability in nondiabetic patients with intracerebral hemorrhage."

For further information:

DOI:https://doi.org/10.1161/STROKEAHA.121.034928