Effect of glucose on functional outcome and case-fatality in patients with spontaneous intracerebral hemorrhage.

BACKGROUND

Hyperglycemia at presentation in patients with intracerebral hemorrhage (ICH) is associated with poor outcome and higher mortality rates. This study assessed the relationship between glucose levels at presentation in ICH patients with functional outcome at three months, case-fatality at thirty days and one-year mortality in a large regional hospital in the Netherlands.

METHODS

In this cohort study, we retrospectively collected patients with ICH that presented between 2019 and 2023 based on pre-specified stroke registration forms. Data collected included blood glucose levels, hyperglycemia (≥ 7.8 mmol/l), HbA1c at presentation, functional outcomes at three months (modified Rankin Scale (mRS)), 30-day case-fatality and one-year mortality. The primary outcome was unfavorable functional outcome, defined as mRS score 3–6. Secondary outcomes included 30-day case-fatality and one-year mortality. We explored the association between glucose levels and hyperglycemia and outcomes variables. Multivariable analysis was performed using a logistic regression model adjusted for potential confounders.

RESULTS

We included 375 of 575 patients with ICH. Neither glucose level nor hyperglycemia were associated with unfavorable outcome after three months. However, glucose levels (aOR 1.25, 95%CI 1.08–1.46) and hyperglycemia (aOR 2.13, 95%CI 1.05–4.32) were both associated with 30-day case-fatality. Higher glucose levels showed a trend towards increased one-year mortality (aOR 1.15, 95%CI 1.00-1.32) and hyperglycemia was associated with one-year mortality (aOR 2.04, 95%CI 1.06–3.95).

CONCLUSION

Neither high blood glucose levels nor hyperglycemia were associated with unfavorable functional outcome after three months in ICH patients. However, ICH patients with high blood glucose levels or hyperglycemia had a significantly higher 30-day case-fatality and one-year mortality. Further studies are needed to understand the pathophysiologic mechanisms of hyperglycemia in ICH and to determine whether strict glucose management provides additional benefit in treating ICH patients.