Association of Serum Glucose Concentrations During Acute Hospitalization with Hematoma Expansion, Perihematomal Edema, a
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ORIGINAL ARTICLE
Association of Serum Glucose Concentrations During Acute Hospitalization with Hematoma Expansion, Perihematomal Edema, and Three Month Outcome Among Patients with Intracerebral Hemorrhage Adnan I. Qureshi • Yuko Y. Palesch • Renee Martin • Jill Novitzke • Salvador Cruz-Flores • Asad Ehtisham • Mustapha A. Ezzeddine • Joshua N. Goldstein • Jawad F. Kirmani • Haitham M. Hussein • M. Fareed K. Suri • Nauman Tariq • Yuan Liu • ATACH Investigators Published online: 15 May 2011 Ó Springer Science+Business Media, LLC 2011
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 A. I. Qureshi (&) J. Novitzke M. A. Ezzeddine H. M. Hussein M. F. K. Suri N. Tariq Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, Minneapolis, MN 55455, USA e-mail: [email protected] Y. Y. Palesch R. Martin Division of Biostatistics and Epidemiology, Medical University of South Carolina, Charleston, SC, USA S. Cruz-Flores St. Louis Univ Health Sciences Center, St. Louis, MO, USA A. Ehtisham Neuroscience Critical Care Unit, Via Christi Regional Medical Center, University of Kansas School of Medicine, Wichita, KS, USA J. N. Goldstein Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA J. F. Kirmani Neuroscience Institute, John F. Kennedy Medical Center, Edison, NJ, USA Y. Liu Emory University, Atlanta, GA, USA
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blood pressure (SBP) C170 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 (B33 vs. >33%); and relative perihematomal edema expansion at 24 h (B40 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 (
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