The influence of diabetes and hyperglycemia on clinical course after intracerebral hemorrhage
Abstract
Objective: To determine whether diabetes and admission hyperglycemia in nondiabetic patients influence outcome and the occurrence of cerebral and medical complications after intracerebral hemorrhage (ICH).
Methods: The study sample included 764 patients with ICH. The effects of diabetes and admission hyperglycemia were examined in relation to 30-day and 3-month mortality using Cox regression models controlling for potential confounders. The analysis was conducted for the entire sample of patients and repeated in comatose and noncomatose patients.
Results: Among comatose patients, neither diabetes nor admission hyperglycemia contributed significant predictive information, as nearly all patients died. In noncomatose patients, diabetes was an independent predictor of 30-day (odds ratio [OR] 1.31; 95% CI 1.08 to 1.58) and 3-month (OR 1.30; 95% CI 1.08 to 1.56) mortality and was associated with a greater incidence of infectious (OR 1.24; 95% CI 1.03 to 1.49) and cerebral (OR 1.42; 95% CI 1.10 to 1.83) complications. Among nondiabetic patients with Glasgow Coma Scale score of >8, hyperglycemia was an independent predictor of 30-day (OR 1.29; 95% CI 1.05 to 1.58) and 3-month (OR 1.27; 95% CI 1.05 to 1.53) mortality and was associated with a greater incidence of cerebral complications (OR 1.47; 95% CI 1.12 to 2.94).
Conclusions: Both diabetes and admission hyperglycemia in nondiabetic patients are predictors of poor outcome after supratentorial ICH. This may be related to the greater incidence of cerebral and infectious complications in diabetic patients and of cerebral complications in hyperglycemic nondiabetic patients.
Get full access to this article
View all available purchase options and get full access to this article.
References
1.
Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS. Stroke in patients with diabetes: the Copenhagen Stroke Study. Stroke . 1994; 25: 1977–1984.
2.
Kiers L, Larkins RL, Hopper J, et al. Stroke topography and outcome in relation to hyperglycemia and diabetes. J Neurol Neurosurg Psychiatry . 1992; 55: 263–270.
3.
Toni D, Saccheti ML, Argentino C, et al. Does hyperglycaemia play a role on the outcome of acute ischaemic stroke patients? J Neurol . 1992; 239: 382–386.
4.
Rytter L, Froelsen S, Beck–Nielsen H. Prevalence and mortality of acute myocardial infarction in patients with diabetes mellitus. Diabetes Care . 1985; 8: 230–234.
5.
Smith JW, Marcus FI, Serokman R. Prognosis of patients with diabetes mellitus after acute myocardial infarction. Am J Cardiol . 1984; 54: 718–721.
6.
Williams LS, Rotich J, Fineberg N, et al. Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke. Neurology . 2002; 59: 67–71.
7.
Bruno A, Biller J, Adams HP Jr, et al. Acute blood glucose level and outcome from ischemic stroke. Neurology . 1999; 52: 280–284.
8.
Sacco RL, Shi T, Zamanillo MC, Kargman DE. Predictors of mortality and recurrence after hospitalized cerebral infarction in an urban community: the Northern Manhattan Stroke Study. Neurology . 1994; 44: 626–634.
9.
Weir CJ, Murray GD, Dyker AG, Lees KR. Is hyperglycemia an independent predictor of poor outcome after acute stroke? Results of a long term follow up study. Br Med J . 1997; 314: 1303–1306.
10.
Kase CS, Furlan AJ, Wechsler LR, et al. Cerebral hemorrhage after intra-arterial thrombolysis for ischemic stroke. The PROACT II trial. Neurology . 2001; 57: 1603–1610.
11.
Demchuk AM, Morgenstern LB, Krieger DW, et al. Serum glucose level and diabetes predict tissue plasminogen activator-related intracerebral hemorrhage in acute ischemic stroke. Stroke . 1999; 30: 34–39.
12.
Bruno A, Levine SR, Frankel MR, et al. Admission glucose level and clinical outcomes in the NINDS rt-PA Stroke Trial. Neurology . 2002; 59: 689–674.
13.
Parsons MW, Barber PA, Desmond PM, et al. Acute hyperglycemia adversely affects stroke outcome: a magnetic resonance imaging and spectroscopy study. Ann Neurol . 2002; 52: 20–28.
14.
Kushner M, Nencini P, Reivich M, et al. Relation of hyperglycemia early in ischemic brain infarction to cerebral anatomy, metabolism, and clinical outcome. Ann Neurol . 1990; 28: 129–135.
15.
Woo E, Chan YW, Yu YL, Huang CY. Admission glucose level in relation to mortality and morbidity outcome in 252 stroke patients. Stroke . 1988; 19: 185–191.
16.
Woo J, Lam CWK, Kay R, Wong AHY, Teoh R, Nicholls G. The influence of hyperglycemia and diabetes mellitus on immediate and 3-month morbidity and mortality after acute stroke. Arch Neurol . 1990; 47: 1174–1177.
17.
Tuhrim S, Dambrosia JM, Price TR, et al. Intracerebral hemorrhage: external validation and extension of a model for prediction of 30-day survival. Ann Neurol . 1991; 29: 658–663.
18.
Arboix A, Massons J, Garcia–Eroles L, Oliveres M, Targa C. Diabetes is an independent risk factor for in-hospital mortality from acute spontaneous intracerebral hemorrhage. Diabetes Care . 2000; 23: 1527–1532.
19.
Kothari RU, Brott T, Broderick JP, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke . 1996; 27: 1304–1305.
20.
Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G. Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke . 1993; 24: 987–993.
21.
Tuhrim S, Dambrosia JM, Price TR, et al. Intracerebral hemorrhage: external validation and extension of a model for prediction of 30-day survival. Ann Neurol . 1991; 29: 685–663.
22.
Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke . 2001; 32: 2426–2432.
23.
Lithner F, Asplund K, Eriksson S, Hagg E, Strand T, Wester P-O. Clinical characteristics in diabetic stroke patients. Diabete Metab . 1988; 14: 15–19.
24.
Kawai N, Keep RF, Betz AL. Effects of hyperglycemia on cerebral blood flow and edema formation after carotid artery occlusion in Fischer 344 rats. Acta Neurochir [Suppl] (Wien) . 1997; 70: 34–36.
25.
Pulsinelli WA, Waldmann S, Rawlinson D, Plum F. Moderate hyperglycemia augments ischemic brain damage: a neuropathologic study in rats. Neurology . 1982; 32: 1239–1246.
26.
Dietrich WS, Alonso O, Busto R. Moderate hyperglycemia worsens acute blood–brain barrier injury after forebrain ischemia in rats. Stroke . 1993; 24: 11–16.
27.
de Courten – Myers GM, Kleinholz M, Holm P, Schmitt G, Wagner KR, Myers RE. Hemorrhagic infarct conversion in experimental stroke. Ann Emerg Med . 1992; 21: 120–125.
28.
WHO Study Group on Diabetes Mellitus. World Health Organization technical report series 727. Geneva: World Health Organization, 1985.
Information & Authors
Information
Published In
Copyright
© 2003.
Publication History
Received: May 15, 2003
Accepted: July 29, 2003
Published online: November 24, 2003
Published in print: November 25, 2003
Authors
Metrics & Citations
Metrics
Citations
Download Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.
Cited By
- Prognostic significance of the stress hyperglycemia ratio and admission blood glucose in diabetic and nondiabetic patients with spontaneous intracerebral hemorrhage, Diabetology & Metabolic Syndrome, 16, 1, (2024).https://doi.org/10.1186/s13098-024-01293-0
- Hyperglycemia enhances brain susceptibility to lipopolysaccharide-induced neuroinflammation via astrocyte reprogramming, Journal of Neuroinflammation, 21, 1, (2024).https://doi.org/10.1186/s12974-024-03136-1
- Prediction of Death in Intracerebral Hemorrhage Patients After Minimally Invasive Surgery by Vital Signs and Blood Glucose, World Neurosurgery, 184, (e84-e94), (2024).https://doi.org/10.1016/j.wneu.2024.01.061
- Stress hyperglycemia is associated with longer ICU length of stay after endoscopic intracerebral hemorrhage evacuation, Journal of Stroke and Cerebrovascular Diseases, 33, 10, (107911), (2024).https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.107911
- Recent trends of treatment strategies and outcomes of basal ganglia hemorrhages at a single institution, Brain Hemorrhages, (2024).https://doi.org/10.1016/j.hest.2024.03.001
- The impact of experimental diabetes on intracerebral haemorrhage. A preclinical study, Biomedicine & Pharmacotherapy, 176, (116834), (2024).https://doi.org/10.1016/j.biopha.2024.116834
- Intracerebral Hemorrhage, Handbook of Cerebrovascular Disease and Neurointerventional Technique, (965-1000), (2024).https://doi.org/10.1007/978-3-031-45598-8_17
- Hot Spots for the Use of Intranasal Insulin: Cerebral Ischemia, Brain Injury, Diabetes Mellitus, Endocrine Disorders and Postoperative Delirium, International Journal of Molecular Sciences, 24, 4, (3278), (2023).https://doi.org/10.3390/ijms24043278
- Caring for Patients With Diabetes in Stroke Neurology, Stroke, 54, 3, (894-904), (2023).https://doi.org/10.1161/STROKEAHA.122.038163
- Incidence of Stroke in People With Diabetes Compared to Those Without Diabetes: A Systematic Review, Experimental and Clinical Endocrinology & Diabetes, 131, 09, (476-490), (2023).https://doi.org/10.1055/a-2106-4732
- See more
Loading...
View Options
Get Access
Login options
Check if you have access through your login credentials or your institution to get full access on this article.
Personal login Institutional LoginPurchase Options
The neurology.org payment platform is currently offline. Our technical team is working as quickly as possible to restore service.
If you need immediate support or to place an order, please call or email customer service:
- 1-800-638-3030 for U.S. customers - 8:30 - 7 pm ET (M-F)
- 1-301-223-2300 for customers outside the U.S. - 8:30 - 7 pm ET (M-F)
- [email protected]
We appreciate your patience during this time and apologize for any inconvenience.