Abstract
OBJECTIVE: To assess the effect of admission blood glucose on hematoma volume in intracerebral hemorrhage (ICH).
BACKGROUND: Admission blood glucose (BG) is a predictor of poor outcome in patients with ICH. We tested the hypothesis that this may be due to an effect on hematoma volume (presumably from transient endothelial dysfunction).
DESIGN/METHODS: Records of patients with primary ICH from a community hospital and two teaching hospitals over 36 months were reviewed. Traumatic and subarachnoid hemorrhages were excluded. Patient demographics, history of diabetes, BG and modified rankin scale (mRS) at discharge were calculated. An mRS of 0- 2 was defined as good outcome and 3-6 was considered a poor outcome. Hematoma volume was calculated on the admission CT by using the formula of ABC/2.
RESULTS: The analysis included 168 patients (mean age 62±13 years;51.8% males). Of the patients, 23.8% had a prior history of diabetes and 33.9% presented with an admission BG>140 mg/dl. The mean ICH volume among patients with BG>140 mg/dl was 65±76.3 cm3 vs. 21.6±27.9 cm3 in those with BG<140 mg/dl (p<0.0010). A history of diabetes did not correlate with hematoma volume (p=0.19). Among those with a BG>140 mg/dl, 84.5% had a bad outcome compared to 63.6 % among those with BG<140 (p=0.004).In a logistic regression model patients with BG>140 mg/dl were three times more likely to have a poor outcome at discharge (OR 3.1;CI 1.4–6.9). Upon correcting for hematoma volume, admission blood glucose no longer correlated with discharge outcome (p=0.3), suggesting that the effect of high BG on outcome may be due to increased hematoma volumes.
CONCLUSIONS: Acute elevation of blood glucose rather than a history of diabetes predicts higher hematoma volumes in ICH. Transient endothelial dysfunction needs to be evaluated as a potential mechanism mediating this association. Further analysis to study whether blood glucose control prevents hematoma expansion is warranted.
Disclosure: Dr. Kubiak has nothing to disclose. Dr. Mohamed has nothing to disclose. Dr. Bhattacharya has nothing to disclose.
Wednesday, March 20 2013, 2:00 pm-7:00 pm
- Copyright © 2013 by AAN Enterprises, Inc.
Disputes & Debates: Rapid online correspondence
NOTE: All authors' disclosures must be entered and current in our database before comments can be posted. Enter and update disclosures at http://submit.neurology.org. Exception: replies to comments concerning an article you originally authored do not require updated disclosures.
- Stay timely. Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- 200 words maximum.
- 5 references maximum. Reference 1 must be the article on which you are commenting.
- 5 authors maximum. Exception: replies can include all original authors of the article.
- Submitted comments are subject to editing and editor review prior to posting.