Association of Admission Hyperglycemia with Clinical Outcomes in Patients with Symptomatic Intracranial Hemorrhage After Endovascular Treatment for Large Vessel Occlusive Stroke

Overview

Journal Clin Interv Aging

Publisher Dove Medical Press

Specialty Geriatrics

Date 2024 Sep 30

PMID 39347479

Authors

Jie Yan

Jiandi Huang

Tianqiang Pu

Jiaxing Song

Jie Yang

Linyu Li

Fengli Li

Wenjie Zi

Changwei Guo

Zhouzhou Peng

Affiliations

Soon will be listed here.

Abstract

Background: Symptomatic intracranial hemorrhage (sICH) is a fatal complication after endovascular treatment (EVT) for acute large vessel occlusive (LVO) stroke. The aim of this study was to investigate the association between hyperglycemia and outcomes in patients with postprocedural sICH.

Methods: Of the 2567 patients with AIS who underwent EVT from two large multicenter randomized trials and two prospective multicenter registry studies, 324 patients occurred sICH with documented admission glucose were included in this study. The primary outcome was functional independence (defined as a modified Rankin Scale score of 0 to 2) at 90 days. Secondary outcomes included mRS score of 0 to 3, 0 to 1, and mRS score at 90 days. Safety outcome was the mortality within 90 days. Admission hyperglycemia was defined as a plasma blood glucose ≥7.8 mmol/L (140 mg/dL) in our analysis.

Results: Of 324 eligible participants included in this study, hyperglycemia was observed in 130 (40.1%) patients. The median age was 67 (IQR, 58-75) years, and median blood glucose level was 7.1 (IQR, 6.0-9.3) mmol/L. After adjusting for confounding variables, admission hyperglycemia was associated with decreased odds of functional independence (adjusted odds ratio[OR] 0.34; 95% CI 0.17-0.68; P= 0.003), decreased odds of favorable outcome (adjusted OR 0.31; 95% CI 0.16-0.58; P < 0.001) and increased odds of mortality (adjusted OR 2.56; 95% CI 1.47-4.45; P = 0.001) at 90 days. After 1:1 propensity score matching analysis, the results were consistent with multivariable logistic regression analysis.

Conclusion: In patients who suffered sICH after EVT for acute large vessel occlusive stroke, hyperglycemia is a strong predictor of poor clinical outcome and mortality at 90 days.

References

Saver J, Goyal M, Bonafe A, Diener H, Levy E, Pereira V . Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015; 372(24):2285-95. DOI: 10.1056/NEJMoa1415061. View

Mitsios J, Ekinci E, Mitsios G, Churilov L, Thijs V . Relationship Between Glycated Hemoglobin and Stroke Risk: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2018; 7(11). PMC: 6015363. DOI: 10.1161/JAHA.117.007858. View

von Kummer R, Broderick J, Campbell B, Demchuk A, Goyal M, Hill M . The Heidelberg Bleeding Classification: Classification of Bleeding Events After Ischemic Stroke and Reperfusion Therapy. Stroke. 2015; 46(10):2981-6. DOI: 10.1161/STROKEAHA.115.010049. View

Kim J, Jahan R, Saver J . Impact of Glucose on Outcomes in Patients Treated With Mechanical Thrombectomy: A Post Hoc Analysis of the Solitaire Flow Restoration With the Intention for Thrombectomy Study. Stroke. 2015; 47(1):120-7. DOI: 10.1161/STROKEAHA.115.010753. View

Goyal M, Demchuk A, Menon B, Eesa M, Rempel J, Thornton J . Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015; 372(11):1019-30. DOI: 10.1056/NEJMoa1414905. View

Capes S, Hunt D, Malmberg K, Pathak P, Gerstein H . Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke. 2001; 32(10):2426-32. DOI: 10.1161/hs1001.096194. View

van Swieten J, Koudstaal P, Visser M, Schouten H, van Gijn J . Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988; 19(5):604-7. DOI: 10.1161/01.str.19.5.604. View

Moghissi E, Korytkowski M, DiNardo M, Einhorn D, Hellman R, Hirsch I . American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract. 2009; 15(4):353-69. DOI: 10.4158/EP09102.RA. View

Coutinho M, Gerstein H, Wang Y, Yusuf S . The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years. Diabetes Care. 1999; 22(2):233-40. DOI: 10.2337/diacare.22.2.233. View

10.

Rosso C, Corvol J, Pires C, Crozier S, Attal Y, Jacqueminet S . Intensive versus subcutaneous insulin in patients with hyperacute stroke: results from the randomized INSULINFARCT trial. Stroke. 2012; 43(9):2343-9. DOI: 10.1161/STROKEAHA.112.657122. View

11.

Ergul A, Abdelsaid M, Fouda A, Fagan S . Cerebral neovascularization in diabetes: implications for stroke recovery and beyond. J Cereb Blood Flow Metab. 2014; 34(4):553-63. PMC: 3982092. DOI: 10.1038/jcbfm.2014.18. View

12.

Yazawa Y, Ohira T, Itabashi R, Uchida K, Sakai N, Yamagami H . Association of Admission Hyperglycemia with Clinical Outcomes in Japanese Patients with Acute Large Vessel Occlusion Stroke: A post hoc Analysis of the Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism Japan Registry 2. Cerebrovasc Dis. 2020; 50(1):12-19. DOI: 10.1159/000511679. View

13.

Powers W, Rabinstein A, Ackerson T, Adeoye O, Bambakidis N, Becker K . Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American.... Stroke. 2019; 50(12):e344-e418. DOI: 10.1161/STR.0000000000000211. View

14.

van Kranendonk K, Treurniet K, Boers A, Berkhemer O, van den Berg L, Chalos V . Hemorrhagic transformation is associated with poor functional outcome in patients with acute ischemic stroke due to a large vessel occlusion. J Neurointerv Surg. 2018; 11(5):464-468. DOI: 10.1136/neurintsurg-2018-014141. View

15.

Rinkel L, Nguyen T, Guglielmi V, Groot A, Posthuma L, Roos Y . High Admission Glucose Is Associated With Poor Outcome After Endovascular Treatment for Ischemic Stroke. Stroke. 2020; 51(11):3215-3223. DOI: 10.1161/STROKEAHA.120.029944. View

16.

Hao Y, Yang D, Wang H, Zi W, Zhang M, Geng Y . Predictors for Symptomatic Intracranial Hemorrhage After Endovascular Treatment of Acute Ischemic Stroke. Stroke. 2017; 48(5):1203-1209. DOI: 10.1161/STROKEAHA.116.016368. View

17.

Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M . Intensive insulin therapy in critically ill patients. N Engl J Med. 2002; 345(19):1359-67. DOI: 10.1056/NEJMoa011300. View

18.

Curran-Everett D, Milgrom H . Post-hoc data analysis: benefits and limitations. Curr Opin Allergy Clin Immunol. 2013; 13(3):223-4. DOI: 10.1097/ACI.0b013e3283609831. View

19.

Berkhemer O, Fransen P, Beumer D, van den Berg L, Lingsma H, Yoo A . A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2014; 372(1):11-20. DOI: 10.1056/NEJMoa1411587. View

20.

Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters P, Milants I . Intensive insulin therapy in the medical ICU. N Engl J Med. 2006; 354(5):449-61. DOI: 10.1056/NEJMoa052521. View