Wu Teddy Y, Putaala Jukka, Sharma Gagan, Strbian Daniel, Tatlisumak Turgut, Davis Stephen M, Meretoja Atte
Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Australia
Department of Neurology, Helsinki University Hospital, Helsinki, Finland.
J Am Heart Assoc. 2017 Aug 2;6(8):e005760. doi: 10.1161/JAHA.117.005760.
Hyperglycemia may be associated with worse outcome after intracerebral hemorrhage (ICH). We assessed the association of early glycemic trajectory on ICH mortality and edema growth.
We included patients from the Helsinki ICH study with glucose measurements at least once between both 0 to 24 and 24 to 72 hours from onset. Hyperglycemia was defined as blood glucose ≥8 mmol/L (144 mg/dL) based on the local threshold for treatment. Glycemic trajectory was defined on maximum values 0 to 24 and 24 to 72 hours after ICH: (1) persistent normoglycemia in both epochs; (2) late hyperglycemia (only between 24 and 72 hours); (3) early hyperglycemia (only before 24 hours); and (4) persistent hyperglycemia in both epochs. Logistic regression with known predictors of outcome estimated the association of glycemic trajectory and 6-month mortality. A generalized linear model assessed the association of glycemic trajectory and interpolated 72-hour edema extension distance. A total of 576 patients met eligibility criteria, of whom 214 (37.2%) had persistent normoglycemia, 44 (7.6%) late hyperglycemia, 151 (26.2%) early hyperglycemia, and 167 (29.0%) 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 associated with 6-month mortality (odds ratio 3.675, 95% CI 1.989-6.792; <0.001). Both univariate (=0.426) and multivariable (=0.493) generalized linear model analyses showed no association between glycemic trajectory and 72-hour edema extension distance.
Early hyperglycemia after ICH is harmful if it is persistent. Strategies to achieve glycemic control after ICH may influence patient outcome and need to be assessed in clinical trials.
脑出血（ICH）后高血糖可能与更差的预后相关。我们评估了早期血糖变化轨迹与ICH死亡率及水肿进展的相关性。
我们纳入了赫尔辛基ICH研究中的患者，这些患者在发病后0至24小时和24至72小时之间至少有一次血糖测量值。根据当地治疗阈值，高血糖定义为血糖≥8 mmol/L（144 mg/dL）。血糖变化轨迹根据ICH后0至24小时和24至72小时的最大值定义：（1）两个时间段均持续血糖正常；（2）晚期高血糖（仅在24至72小时之间）；（3）早期高血糖（仅在24小时之前）；（4）两个时间段均持续高血糖。使用已知的预后预测因素进行逻辑回归，估计血糖变化轨迹与6个月死亡率的相关性。广义线性模型评估血糖变化轨迹与插值72小时水肿扩展距离的相关性。共有576例患者符合纳入标准，其中214例（37.2%）持续血糖正常，44例（7.6%）晚期高血糖，151例（26.2%）早期高血糖，167例（29.0%）持续高血糖。持续高血糖组（51.1%）和早期高血糖组（26.3%）的6个月死亡率高于血糖正常组（19.0%）和晚期高血糖组（3.6%）。持续高血糖与6个月死亡率相关（比值比3.675，95%可信区间1.989 - 6.792；P<0.001）。单变量（P = 0.426）和多变量（P = 0.493）广义线性模型分析均显示血糖变化轨迹与72小时水肿扩展距离之间无相关性。
ICH后早期高血糖若持续存在则有害。ICH后实现血糖控制的策略可能会影响患者预后，需要在临床试验中进行评估。
