Abstract WP340: Primary Intracerebral Hemorrhage and Perihematomal Edema Volumes in Diabetics on Sulfonylureas: A Case-Control Study

Abstract

Introduction: Sulfonylureas (SU) drugs have been linked to reduced cerebral edema, lower rate of hemorrhagic transformation, and improved functional outcome following ischemic stroke, but their effects in primary intracerebral hemorrhage (pICH) have not yet been explored. We investigated whether pre-existing SU use influenced intracerebral hemorrhage (ICH) volume, perihematomal edema (PHE) volume and hospital discharge disposition in type II diabetics (DMII) presenting with pICH. Methods: We performed a retrospective chart review of all diabetic patients presenting with ICH to 2 tertiary academic centers between 2006 and 2016. All patients with DMII, pICH, admission computed tomography (CT) scan, and current SU use at the time of admission were included in our study. For each case, 2 matched controls (by admission date ± 5 years, age ± 5 years, hematoma location [deep vs. lobar], use of antiplatelet agent or anticoagulant) with DMII and pICH were consecutively selected for study inclusion. Intracerebral hemorrhage volumes and PHE volumes were measured via region-of-interest analysis on admission CT for each patient. To mitigate the influence of ICH volume on PHE, the PHE/ICH surface area ratio was calculated. Lastly, hospital discharge disposition was determined for each patient. We utilized the Wilcoxon rank sum test and Fischer’s exact test to assess differences between the 2 groups. Findings: Of 317 patients screened, 21 SU cases and 42 non-SU matched controls met criteria for study inclusion. Patients on SUs had significantly lower admission ICH volumes (median 4mL, IQR 2-30 vs. median 25mL, IQR 6-60; p =0.011), PHE volumes (median 4mL, IQR 0.9-24 vs. median 17, IQR 6-37; p =0.0095), and PHE/ICH surface area ratios (median 0.28, IQR 0.1-0.4 vs. median 0.43, IQR 0.3-0.6; p =0.013) as compared to matched controls. Sulfonylurea use was also associated with improved discharge disposition ( p =0.0062). Conclusions: In patients with type II diabetes and pICH, SU use predicted lower ICH and PHE volumes, lower PHE/ICH surface area ratios, and favorable discharge disposition. Further studies are warranted to better elucidate the potential benefits of SUs in pICH.