Background and purpose: Hyperglycemia may be associated with worse outcome after intracerebral hemorrhage (ICH). We assessed the association of early glycemic trajectory on ICH mortality.
Methods: We included patients from the Helsinki ICH study with glucose measurements at least once between both 0-24 hours and 24-72 hours from ICH onset. Hyperglycemia was defined as blood glucose ≥8 mMol/L (144 mg/dL) based on the local threshold for treatment. Glucose trajectory was defined on maximum values 0-24 hours and 24-72 hours after ICH; 1) persistent normoglycemia in both epochs, 2) late hyperglycemia (only between 24-72 hours), 3) early hyperglycemia (only prior to 24 hours), 4) persistent hyperglycemia in both epochs. Logistic regression adjusted for factors associated with 6-month mortality estimated the association of glycemic trajectory with mortality.
Results: There were 576 patients meeting eligibility criteria, of whom 214 (37.2%) had persistent normoglycemia, 44 (7.6%) late hyperglycemia, 151 (26.2%) early hyperglycemia, and 167 (29%) 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 independently associated with 6-month mortality (OR 3.453; 95% CI 1.863-6.400;p<0.001) adjusted for baseline ICH and oedema volume, age, warfarin use, anti-hypertensive use, baseline Glasgow Coma Scale, National Institutes of Health Stroke Scale and ventricular extension.
Conclusion: Early persistent hyperglycemia is associated with markedly higher risk of mortality after ICH. Strategies to achieve glycemic control after ICH may improve patient outcome and need to be assessed in clinical trials.