Persistent Hyperglycemia Is Associated With Increased Mortality After Intracerebral Hemorrhage

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Wu , T Y , Putaala , J , Sharma , G , Strbian , D , Tatlisumak , T , Davis , S M & Meretoja , A 2017 , ' Persistent Hyperglycemia Is Associated With Increased Mortality After Intracerebral Hemorrhage ' , Journal of the American Heart Association , vol. 6 , no. 8 , 005760 . https://doi.org/10.1161/JAHA.117.005760

Title: Persistent Hyperglycemia Is Associated With Increased Mortality After Intracerebral Hemorrhage
Author: Wu, Teddy Y.; Putaala, Jukka; Sharma, Gagan; Strbian, Daniel; Tatlisumak, Turgut; Davis, Stephen M.; Meretoja, Atte
Contributor: University of Helsinki, Neurologian yksikkö
University of Helsinki, Neurologian yksikkö
University of Helsinki, Neurologian yksikkö
University of Helsinki, Department of Neurosciences
Date: 2017-08
Language: eng
Number of pages: 26
Belongs to series: Journal of the American Heart Association
ISSN: 2047-9980
URI: http://hdl.handle.net/10138/222909
Abstract: Background-Hyperglycemia may be associated with worse outcome after intracerebral hemorrhage (ICH). We assessed the association of early glycemic trajectory on ICH mortality and edema growth. Methods and Results-We included patients from the Helsinki ICH study with glucose measurements at least once between both 0 to 24 and 24 to 72 hours from onset. Hyperglycemia was defined as blood glucose >= 8 mmol/L (144 mg/dL) based on the local threshold for treatment. Glycemic trajectory was defined on maximum values 0 to 24 and 24 to 72 hours after ICH: (1) persistent normoglycemia in both epochs; (2) late hyperglycemia (only between 24 and 72 hours); (3) early hyperglycemia (only before 24 hours); and (4) persistent hyperglycemia in both epochs. Logistic regression with known predictors of outcome estimated the association of glycemic trajectory and 6-month mortality. A generalized linear model assessed the association of glycemic trajectory and interpolated 72-hour edema extension distance. A total of 576 patients met eligibility criteria, of whom 214 (37.2%) had persistent normoglycemia, 44 (7.6%) late hyperglycemia, 151 (26.2%) early hyperglycemia, and 167 (29.0%) persistent hyperglycemia. Six-month mortality was higher in the persistent (51.1%) and early (26.3%) hyperglycemia groups than the normoglycemia (19.0%) and late hyperglycemia (3.6%) groups. Persistent hyperglycemia was associated with 6-month mortality (odds ratio 3.675, 95% CI 1.989-6.792; P <0.001). Both univariate (P=0.426) and multivariable (P=0.493) generalized linear model analyses showed no association between glycemic trajectory and 72-hour edema extension distance. Conclusion-Early hyperglycemia after ICH is harmful if it is persistent. Strategies to achieve glycemic control after ICH may influence patient outcome and need to be assessed in clinical trials.
Subject: edema
glucose
hyperglycemia
intracerebral hemorrhage
mortality
ADMISSION BLOOD-GLUCOSE
PERIHEMATOMAL EDEMA
PROGNOSTIC-SIGNIFICANCE
FUNCTIONAL OUTCOMES
HEMATOMA
STROKE
TRIAL
MANAGEMENT
SURVIVAL
BEDSIDE
3112 Neurosciences
3124 Neurology and psychiatry
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