Abstract
BackgroundAbnormal glucose metabolism was shown to be associated with the occurrence of remote diffusion-weighted imaging lesions (R-DWILs) after primary intracerebral hemorrhage (ICH) onset. Insulin resistance is a metabolic disorder that was regarded as an indicator of chronic systemic inflammation. In this study, we aimed to determine the effect of insulin resistance on the occurrence of R-DWILs in ICH.MethodsPatients with primary ICH within 14 days after onset were prospectively enrolled from November 2017 to October 2019. R-DWILs was defined as remote focal hyperintensity from the hematoma in DWI, with corresponding hypointensity in apparent diffusion coefficient. The homeostasis model assessment of insulin resistance (HOMA-IR) was used for insulin resistance estimation and calculated as fasting insulin (μU/ml) × fasting glucose (mmol/L)/22.5. Patients in our cohort were divided into four groups according to HOMA-IR index quartiles. Logistic regression analysis and smoothing plots were used to evaluate the association of HOMA-IR with R-DWIL occurrence. Sensitivity analysis was performed in non-diabetic patients, non-obese patients, hypertensive ICH patients, and patients 60 years and older separately. The association between HOMA-IR and systemic inflammatory immune indices neutrophil to lymphocyte ratio (NLR) and monocyte to lymphocyte ratio (MLR) was examined with multiple linear regression analysis.ResultsAmong the 345 patients, 54 (15.7%) had R-DWILs. Both the third and fourth quartiles of HOMA-IR index were robustly associated with an increased risk of R-DWIL occurrence (adjusted OR 3.58, 95% CI 1.33-9.65; adjusted OR 3.91, 95%CI 1.47-10.41) when compared with the first quartile. The association was consistent in non-diabetic, non-obese, hypertensive ICH patients, as well as in patients 60 years and older. Furthermore, both NLR and MLR were independently associated with HOMA-IR.ConclusionsOur study suggested that insulin resistance evaluated with HOMA-IR index was independently associated with the presence of R-DWILs in patients with acute and subacute primary ICH. It may provide new insights into the metabolism-related brain injury after ICH ictus.
Highlights
Intracerebral hemorrhage (ICH) is one of the most prevalent subtypes of stroke and remains a significant cause of morbidity and mortality worldwide
A total of 345 of 681 patients with ICH were enrolled in the study, after excluding those with isolated intraventricular hemorrhage (IVH), with secondary causes of hemorrhage, lacking insulin data or being treated with insulin, or with MRI unobtainable (Figure 1)
When compared with patients excluded for lack of MRI data, the patients included in final analysis were less likely to experience severe neurological deficit, to have a history of atrial fibrillation (AF), ICH, and smoking; had a higher BMI, total cholesterol (TC), and low density lipoprotein cholesterol (LDL-C); and had smaller initial hematoma volume (Supplementary Table S1)
Summary
Intracerebral hemorrhage (ICH) is one of the most prevalent subtypes of stroke and remains a significant cause of morbidity and mortality worldwide. Abnormal glucose metabolism was shown to be associated with the occurrence of remote diffusion-weighted imaging lesions (R-DWILs) after primary intracerebral hemorrhage (ICH) onset. The R-DWILs were more likely to occur in those who use antiplatelet drugs before ICH onset, those who presented ventricular hemorrhage, and those who had a higher HOMA-IR index or a higher total cSVD burden score. Patients with higher HOMA-IR were younger, with a higher BMI and LDL-C level, and with higher score of NIHSS at admission, as well as being more likely to have a hypertension history and a higher initial blood pressure, with a higher frequency of diabetes, hypoglycemic treatments, and ventricle extension
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