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Stress-Induced Hyperglycemia and Remote Diffusion-Weighted Imaging Lesions in Primary Intracerebral Hemorrhage

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Abstract

Background and Purpose

Stress-induced hyperglycemia (SIH) is the relative transient increase in glucose during a critical illness such as intracerebral hemorrhage (ICH) and is likely to play an important role in the pathogenesis of remote diffusion-weighted imaging (DWI) lesion (R-DWIL) in primary ICH. We sought to determine the association between SIH and the occurrence of R-DWILs.

Methods

We prospectively enrolled primary ICH patients within 14 days after onset from November 2016 to May 2018. In these patients, cerebral magnetic resonance imaging was performed within 14 days after ICH onset. R-DWIL was defined as a hyperintensity signal in DWI with corresponding hypointensity in apparent diffusion coefficient, and at least 20 mm apart from the hematoma. SIH was measured by stress-induced hyperglycemia ratio (SHR). SHR was calculated by fasting blood glucose (FBG) divided by estimated average glucose derived from glycosylated hemoglobin. The included patients were dichotomized into two groups by the 50th percentile of SHR, and named as SHR (−P50) group and SHR (P50+) group, respectively. We evaluated the association between SHR and R-DWIL occurrence using multivariable logistic regression modeling adjusted for potential confounders.

Results

Among the 288 patients enrolled, forty-six (16.0%) of them had one or more R-DWILs. Compared with the patients in the lower 50% of SHR (SHR [−P50]), the odds ratio (OR) [95% confidence interval (CI)] for the higher 50% of SHR (SHR [P50+]) group for R-DWIL occurrence was 3.13 (1.39–7.07) in the total population and 6.33 (2.19–18.30) in population absent of background hyperglycemia after adjusting for potential covariates. Similar results were observed after further adjusted for FBG.

Conclusions

Our study demonstrated that SIH was associated with the occurrence of R-DWILs in patients with primary ICH within 14 days of symptom onset.

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Acknowledgements

Dr. Ye, Dr. Cai, Dr. Nie, Dr. Chen, Dr. Li, Dr. Xu, Dr. Cai, Dr. Liu, Dr. Yin, Dr. Song, Dr. Tong and Dr. Gao report grants from National Natural Science Foundation of China, grants from Zhejiang Provincial Natural Science Foundation of China, grants from Zhejiang Provincial Science and Technology Project, during the conduct of the study.

Funding

This work was supported by grants from National Natural Science Foundation of China (NSFC) (81471168) to Feng Gao, National Natural Science Foundation of China (NSFC) (81500991) to Lu-sha Tong, Zhejiang Provincial Natural Science Foundation of China (LY17H090003) to Zhi-rong Liu, Zhejiang Provincial Natural Science Foundation of China (LY18H090003) to Xin-zhen Yin, and Zhejiang Provincial Science and Technology Project (2016C37128) to Xue-li Cai.

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Author notes

  1. Xiang-hua Ye, Xue-li Cai, Lu-sha Tong and Feng Gao have contributed equally to this article.

Authors and Affiliations

  1. Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Rd., Hangzhou, 310009, Zhejiang, China

    Xiang-hua Ye, Dong-liang Nie, Ye-jun Chen, Jia-wen Li, Zhi-rong Liu, Xin-zhen Yin, Shui-jiang Song, Lu-sha Tong & Feng Gao

  2. Department of Neurology, Lishui Hospital, Zhejiang University School of Medicine, 289 Kuocang Rd., Lishui, 323000, Zhejiang, China

    Xiang-hua Ye & Xue-li Cai

  3. Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, N1 Shangcheng Rd., Yiwu, 322000, Zhejiang, China

    Xu-hua Xu

  4. Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Rd., Hangzhou, 310009, Zhejiang, China

    Jin-song Cai

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Contributions

X-hY brought up the main idea, developed the protocol, collected and analyzed data, and wrote the manuscript. X-lC developed the protocol, collected part of the data, searched for literatures, and offered some helpful suggestions. D-lN helped developing protocol, found some useful papers and provided helpful input on the theme. Y-jC collected part of the data and searched for useful papers. J-wL and X-hX helped to build the idea and collected part of the data. J-sC helped to read the images. Z-rL, X-zY, and S-jS offered available suggestions to write the manuscript. FG and L-sT supervised and offered guidance to all the authors, revised the manuscript, and polished the language.

Corresponding authors

Correspondence to Lu-sha Tong or Feng Gao.

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The work was approved by the institutional Human Research Ethics Committee of the Second Affiliated Hospital of Zhejiang University.

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Ye, Xh., Cai, Xl., Nie, Dl. et al. Stress-Induced Hyperglycemia and Remote Diffusion-Weighted Imaging Lesions in Primary Intracerebral Hemorrhage. Neurocrit Care 32, 427–436 (2020). https://doi.org/10.1007/s12028-019-00747-y

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