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Association of Serum Glucose Concentrations During Acute Hospitalization with Hematoma Expansion, Perihematomal Edema, and Three Month Outcome Among Patients with Intracerebral Hemorrhage

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Abstract

Background

There is some evidence that hyperglycemia increases the rate of poor outcomes in patients with intracerebral hemorrhage (ICH). We explored the relationship between various parameters of serum glucose concentrations measured during acute hospitalization and hematoma expansion, perihematomal edema, and three month outcome among subjects with ICH.

Methods

A post-hoc analysis of a multicenter prospective study recruiting subjects with ICH and elevated systolic blood pressure (SBP) ≥170 mmHg who presented within 6 h of symptom onset was performed. The serum glucose concentration was measured repeatedly up to 5 times over 3 days after admission and change over time was characterized using a summary statistic by fitting the linear regression model for each subject. The admission glucose, glucose change between admission and 24 hour glucose concentration, and estimated parameters (slope and intercept) were entered in the logistic regression model separately to predict the functional outcome as measured by modified Rankin scale (mRS) at 90 days (0–3 vs. 4–6); hematoma expansion at 24 h (≤33 vs. >33%); and relative perihematomal edema expansion at 24 h (≤40 vs. >40%).

Results

A total of 60 subjects were recruited (aged 62.0 ±15.1 years; 56.7% men). The mean of initial glucose concentration (±standard deviation) was 136.7 mg/dl (±58.1). Thirty-five out of 60 (58%) subjects had a declining glucose over time (negative slope). The risk of poor outcome (mRS 4–6) in those with increasing serum glucose levels was over two-fold relative to those who had declining serum glucose levels (RR = 2.64, 95% confidence interval [CI]: 1.03, 6.75). The RRs were 2.59 (95% CI: 1.27, 5.30) for hematoma expansion >33%; and 1.25 (95% CI: 0.73, 2.13) for relative edema expansion >40%.

Conclusions

Decline in serum glucose concentration correlated with reduction in proportion of subjects with hematoma expansion and poor clinical outcome. These results provide a justification for a randomized controlled clinical trial to evaluate the efficacy of aggressive serum glucose reduction in reducing death and disability among patients with ICH.

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Acknowledgments

The principal investigator, Dr. Qureshi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Authors and Affiliations

  1. Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, Minneapolis, MN, 55455, USA

    Adnan I. Qureshi, Jill Novitzke, Mustapha A. Ezzeddine, Haitham M. Hussein, M. Fareed K. Suri & Nauman Tariq

  2. Division of Biostatistics and Epidemiology, Medical University of South Carolina, Charleston, SC, USA

    Yuko Y. Palesch & Renee Martin

  3. St. Louis Univ Health Sciences Center, St. Louis, MO, USA

    Salvador Cruz-Flores

  4. Neuroscience Critical Care Unit, Via Christi Regional Medical Center, University of Kansas School of Medicine, Wichita, KS, USA

    Asad Ehtisham

  5. Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA

    Joshua N. Goldstein

  6. Neuroscience Institute, John F. Kennedy Medical Center, Edison, NJ, USA

    Jawad F. Kirmani

  7. Emory University, Atlanta, GA, USA

    Yuan Liu

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  1. Adnan I. Qureshi
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Correspondence to Adnan I. Qureshi.

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Qureshi, A.I., Palesch, Y.Y., Martin, R. et al. Association of Serum Glucose Concentrations During Acute Hospitalization with Hematoma Expansion, Perihematomal Edema, and Three Month Outcome Among Patients with Intracerebral Hemorrhage. Neurocrit Care 15, 428–435 (2011). https://doi.org/10.1007/s12028-011-9541-8

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