Abstract
The association between early glycemic change and short-term mortality in non-diabetic patients with acute intracerebral hemorrhage (ICH) is unclear. We retrospectively investigated non-diabetic patients with lobar (n = 262) and non-lobar ICH (n = 370). Each patient had a random serum glucose test on hospital admission and a fasting serum glucose test within the following 48 h. Hyperglycemia was defined as serum glucose ≥ 7.8 mmol/l. Four patterns were determined: no hyperglycemia (reference category), persistent hyperglycemia, delayed hyperglycemia, and decreasing hyperglycemia. Associations with 30-day mortality were estimated using Cox models adjusted for major features of ICH severity. Persistent hyperglycemia was associated with 30-day mortality in both lobar (HR 3.00; 95% CI 1.28–7.02) and non-lobar ICH (HR 4.95; 95% CI 2.20–11.09). In lobar ICH, 30-day mortality was also associated with delayed (HR 4.10; 95% CI 1.77–9.49) and decreasing hyperglycemia (HR 2.01, 95% CI 1.09–3.70). These findings were confirmed in Cox models using glycemic change (fasting minus random serum glucose) as a continuous variable. Our study shows that, in non-diabetic patients with ICH, early persistent hyperglycemia is an independent predictor of short-term mortality regardless of hematoma location. Moreover, in non-diabetic patients with lobar ICH, both a positive and a negative glycemic change are associated with short-term mortality.
Highlights
The association between early glycemic change and short-term mortality in non-diabetic patients with acute intracerebral hemorrhage (ICH) is unclear
Research has consistently shown that admission hyperglycemia and short-term mortality are related in patients with primary intracerebral hemorrhage (ICH), but it is still controversial whether hyperglycemia independently contributes to hemorrhagic injury or it is just a surrogate marker for severe ICH6
Preliminary multivariable-adjusted Cox models for mortality prediction in the study cohort considered as whole confirmed a significant interaction of hematoma location with glycemic change (p < 0.001, both categorical and continuous)
Summary
The association between early glycemic change and short-term mortality in non-diabetic patients with acute intracerebral hemorrhage (ICH) is unclear. In lobar ICH, 30-day mortality was associated with delayed (HR 4.10; 95% CI 1.77–9.49) and decreasing hyperglycemia (HR 2.01, 95% CI 1.09–3.70) These findings were confirmed in Cox models using glycemic change (fasting minus random serum glucose) as a continuous variable. In non-diabetic patients with ICH, early persistent hyperglycemia is an independent predictor of short-term mortality regardless of hematoma location. Published research on the association of glycemic change with ICH mortality is very scant[14,15] This retrospective study investigated the association of early glycemic change with short-term mortality in non-diabetic patients with lobar and non-lobar ICH. The study tested whether inclusion of early glycemic change would improve the prognostic ability for short-term mortality of the ICH score[16], which is the most widely known scale for prognosis estimation in acute ICH p atients[17]
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