Increased Short-Term Mortality in Patients with Spontaneous Intracerebral Hemorrhage and its Association with Admission Glucose Levels and Leukocytosis

Background: The relationship between glycosylated hemoglobin (HbA1c) and prognosis of spontaneous intracerebral hemorrhage (SICH) patients has not been fully elucidated. This study aimed to reveal the relationship between HbA1c levels and short-term mortality after patient admission with SICH.Methods: It was a large-scale, multicenter, cross-sectional study. From August 1, 2015, to July 31, 2019, a total of 41910 SICH patients were included in the study from the Chinese Stroke Center Alliance (CSCA) program. Finally, we comprehensively analyzed the data from 21,116 patients with SICH. HbA1c was categorized into four groups by quartile. Univariate and multivariate logistic regression analyses were used to assess the association between HbA1c levels and short-term mortality in SICH patients.Results: The average age of the 21,116 patients was 62.8 ± 13.2 years; 13,052 (61.8%) of them were male, and 507 (2.4%) of them died. Compared to the higher three quartiles of HbA1c, the lowest quartile (≤5.10%) had higher short-term mortality. In subgroup analysis with or without diabetes mellitus (DM) patients, the mortality of the Q3 group at 5.60–6.10% was significantly lower than that of the Q1 group at ≤5.10%. After adjustment for potential influencing factors, the ROC curve of HbA1c can better predict the short-term mortality of patients with SICH (AUC = 0.6286 P < 0.001).Conclusions: Therefore, we concluded that low or extremely low HbA1c levels (≤5.10%) after stroke were associated with higher short-term mortality in SICH patients, with or without DM.

Download Full-text

Effect of increased glucose levels on short-term outcome in hypertensive spontaneous intracerebral hemorrhage

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2013.12.018 ◽

2014 ◽

Vol 118 ◽

pp. 37-43 ◽

Cited By ~ 21

Author(s):

J.H. Tapia-Pérez ◽

S. Gehring ◽

R. Zilke ◽

T. Schneider

Keyword(s):

Intracerebral Hemorrhage ◽

Spontaneous Intracerebral Hemorrhage ◽

Short Term ◽

Term Outcome ◽

Glucose Levels ◽

Short Term Outcome

Download Full-text

Admission Dehydration Status Portends Adverse Short-Term Mortality in Patients with Spontaneous Intracerebral Hemorrhage

Journal of Clinical Medicine ◽

10.3390/jcm10245939 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5939

Author(s):

Felix Lehmann ◽

Lorena M. Schenk ◽

Joshua D. Bernstock ◽

Christian Bode ◽

Valeri Borger ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Hydration Status ◽

Spontaneous Intracerebral Hemorrhage ◽

Midline Shift ◽

Short Term ◽

Cerebral Herniation ◽

Short Term Mortality ◽

Ich Score ◽

Time Of Admission ◽

The Impact

The impact of dehydration at admission of patients with spontaneous intracerebral hemorrhage (ICH) on short-term mortality remains ambiguous due to scarce data. All of the consecutive patients with spontaneous ICH, who were referred to our neurovascular center in 2018/19, were assessed for hydration status on admission. Dehydration was defined by a blood urea-to-creatinine ratio > 80. In a cohort of 249 patients, 76 patients (31%) were dehydrated at the time of admission. The following factors were significantly and independently associated with increased 30-day mortality in multivariate analysis: “signs of cerebral herniation” (p = 0.008), “initial midline shift > 5 mm” (p < 0.001), “ICH score > 3” (p = 0.007), and “admission dehydration status” (p = 0.007). The results of the present study suggest that an admission dehydration status might constitute a significant and independent predictor of short-term mortality in patients with spontaneous ICH.

Download Full-text

Association of early glycemic change with short-term mortality in lobar and non-lobar intracerebral hemorrhage

Scientific Reports ◽

10.1038/s41598-021-95453-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Paola Forti ◽

Fabiola Maioli ◽

Marco Zoli

Keyword(s):

Intracerebral Hemorrhage ◽

Continuous Variable ◽

Serum Glucose ◽

Diabetic Patients ◽

Short Term ◽

Cox Models ◽

Short Term Mortality ◽

Glucose Test ◽

Acute Intracerebral Hemorrhage ◽

Persistent Hyperglycemia

AbstractThe association between early glycemic change and short-term mortality in non-diabetic patients with acute intracerebral hemorrhage (ICH) is unclear. We retrospectively investigated non-diabetic patients with lobar (n = 262) and non-lobar ICH (n = 370). Each patient had a random serum glucose test on hospital admission and a fasting serum glucose test within the following 48 h. Hyperglycemia was defined as serum glucose ≥ 7.8 mmol/l. Four patterns were determined: no hyperglycemia (reference category), persistent hyperglycemia, delayed hyperglycemia, and decreasing hyperglycemia. Associations with 30-day mortality were estimated using Cox models adjusted for major features of ICH severity. Persistent hyperglycemia was associated with 30-day mortality in both lobar (HR 3.00; 95% CI 1.28–7.02) and non-lobar ICH (HR 4.95; 95% CI 2.20–11.09). In lobar ICH, 30-day mortality was also associated with delayed (HR 4.10; 95% CI 1.77–9.49) and decreasing hyperglycemia (HR 2.01, 95% CI 1.09–3.70). These findings were confirmed in Cox models using glycemic change (fasting minus random serum glucose) as a continuous variable. Our study shows that, in non-diabetic patients with ICH, early persistent hyperglycemia is an independent predictor of short-term mortality regardless of hematoma location. Moreover, in non-diabetic patients with lobar ICH, both a positive and a negative glycemic change are associated with short-term mortality.

Download Full-text

Abstract P411: Prevalence, Characteristics and Outcomes of Undetermined Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

Stroke ◽

10.1161/str.52.suppl_1.p411 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Konark MALHOTRA ◽

Christina Zompola ◽

Aikaterini Theodorou ◽

Aristeidis Katsanos ◽

Ashkan Shoamanesh ◽

...

Keyword(s):

Systematic Review ◽

Intracerebral Hemorrhage ◽

Meta Analysis ◽

Amyloid Angiopathy ◽

Short Term ◽

Pooled Prevalence ◽

Subgroup Analyses ◽

Short Term Mortality ◽

Cerebral Amyloid ◽

Undetermined Etiology

Objective: We sought to determine the prevalence, radiological characteristics, and clinical outcomes of intracerebral hemorrhage (ICH) of undetermined etiology. Methods: Systematic review and meta-analysis of studies involving patients with spontaneous ICH was conducted to assess the prevalence and clinical-radiological characteristics of undetermined ICH. Additionally, we assessed the rates for ICH secondary to hypertensive arteriopathy (HTN-A) and cerebral amyloid angiopathy (CAA). Subgroup analyses were performed based on the use of a) etiology-oriented ICH classification, b) detailed neuroimaging, and c) Boston criteria among CAA-ICH. Results: 24 studies were included (n=15,828; mean age: 64.8 years, males: 60.8%). The pooled prevalence of HTN-A ICH, undetermined ICH and CAA-ICH were 50% (95%CI: 43-58%), 18% (95%CI: 13-23%), and 12% (95%CI: 7-17%; p<0.001 between subgroups). The volume of ICH was largest in CAA-ICH 24.7mL (95%CI: 19.7-29.8mL), followed by HTN-A ICH 16.2mL (95%CI: 10.9-21.5mL) and undetermined ICH 15.4mL (95%CI: 6.2-24.5mL). Among patients with undetermined ICH, the rates of short-term mortality and intraventricular hemorrhage were 33% (95%CI: 25-42%) and 38% (95%CI: 28-48%), respectively. Subgroup analysis demonstrated a higher rate of undetermined ICH among studies that did not use an etiology-oriented classification (22%; 95%CI: 15-29%). No difference was observed between studies based on the completion of detailed neuroimaging to assess the rates of undetermined ICH (p=0.62). Conclusions: The etiology of spontaneous ICH remains undetermined among one in five patients in studies using etiology-oriented classification and among one in four patients in studies that avoid using etiology-oriented classification. The short-term mortality in undetermined ICH is high despite the relatively small ICH volume. Our findings suggest the use of etiology-oriented classification to approach ICH patients (Figure).

Download Full-text

Comments on “Short-Term Outcome of Spontaneous Intracerebral Hemorrhage in Algarve, Portugal: Retrospective Hospital-Based Study”

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2018.01.016 ◽

2018 ◽

Vol 27 (6) ◽

pp. 1721

Author(s):

Saeid Safiri ◽

Ahad Ashrafi-Asgarabad

Keyword(s):

Intracerebral Hemorrhage ◽

Spontaneous Intracerebral Hemorrhage ◽

Short Term ◽

Term Outcome ◽

Short Term Outcome

Download Full-text

Poor intensive stroke care is associated with short-term death after spontaneous intracerebral hemorrhage

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2020.105696 ◽

2020 ◽

Vol 191 ◽

pp. 105696

Author(s):

Joana Martinez ◽

Maria Mouzinho ◽

Joana Teles ◽

Patrícia Guilherme ◽

Jerina Nogueira ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Stroke Care ◽

Spontaneous Intracerebral Hemorrhage ◽

Short Term

Download Full-text

Predictors of Supratentorial Deep Intracerebral Hemorrhage Volume and Their Effect on Short-Term Mortality in Asians

Cerebrovascular Diseases ◽

10.1159/000446552 ◽

2016 ◽

Vol 42 (5-6) ◽

pp. 319-331 ◽

Cited By ~ 4

Author(s):

Myung Hoon Han ◽

Jae Min Kim ◽

Hyeong-Joong Yi ◽

Jin Hwan Cheong ◽

Yong Ko ◽

...

Keyword(s):

Alcohol Consumption ◽

Intracerebral Hemorrhage ◽

Regression Line ◽

Normal Weight ◽

Short Term ◽

Risk Of Death ◽

Increased Risk ◽

Short Term Mortality ◽

Relevant Variables ◽

Underlying Mechanisms

Background: The volume of intracerebral hemorrhage (ICH) measured at hospital admission is the strongest predictor of clinical outcomes in patients with ICH. Despite the high incidence rate of ICH in Asians, there is lack of data regarding predictors of ICH volume in this ethnic group. The purpose of this study was to determine predictors of deep ICH volume and examine their effect on short-term mortality in Asians. Methods: Hematoma volume was measured using the ABC/2 method. ICH volume was transformed to the natural log scale to normalize distributions for all analyses. We estimated the coefficients of ICH volume based on relevant predictors using multivariable linear regression. We also determined the association between body mass index (BMI) and ICH volume using a regression line and a line determined by a locally weighted scatter plot smoothing. Results: A total of 1,039 patients from 2 twin hospitals in Korea who were admitted with primary spontaneous supratentorial deep ICH over a 12-year period were enrolled in this study. The median ICH volume was 19.7 ml. The average patient age was 59.2, and 62.4% of patients were men. The mean ICH volume showed a gradual, approximately 2% decrease per 1 BMI increase in the current study, after adjusting for all relevant variables (β = -0.024; SE 0.004; p < 0.001). In addition, patients with frequent alcohol consumption showed a 10% increase in mean ICH volume (β = 0.098; SE 0.041; p = 0.016), and patients undergoing warfarin treatment showed a 30% increase in mean ICH volume after full adjustment of all relevant variables (β = 0.296; SE 0.050; p < 0.001). Relative to overweight patients, there was a 47, 11, and 18% increase in admission mean ICH volume in underweight, normal weight and obese patients, respectively. Patients in the first quartile and underweight BMI groups had 1.45-fold (hazard ratio (HR) 1.45; 95% CI 1.03-2.03; p = 0.035) and 1.77-fold (HR 1.77; 95% CI 1.10-2.84; p = 0.019) higher increased risk of death during the first 3 months after ICH, retrospectively. In addition, patients in groups with frequent alcohol consumption and warfarin use both showed a significant association with mortality 90 days after ICH. Conclusions: We demonstrated the association between various predictors and admission ICH volume with short-term mortality in Asians. Further studies are needed to account for these observations and determine their underlying mechanisms.

Download Full-text