Hyperglycemia and outcome in intracerebral hemorrhage: from bedside to bench-more study is needed

Hyperglycemia on admission has been associated with poor outcome after intracerebral hemorrhage (ICH). However, the mechanistic links between hyperglycemia and poor outcome are not fully elucidated. We sought to determine the relationship between the serum glucose levels during the first 72 h after ICH, and evolution of hematoma and perihematomal edema (PHE), and functional outcome at 3 months and performed a retrospective review of prospectively collected data from 135 consecutive ICH patients. Patients were divided into two groups based on their mean glucose level-high (≥150 mg/dl) vs. controlled (<150 mg/dl). We used Chi-square test and multiple logistic regressions to assess the relationship between glucose level and outcome variables, including hematoma expansion (HE), PHE growth, and modified Rankin Scale (mRS) score at 3 months. The mean 72-h glucose level was 123 ± 16 for the controlled group and 190 ± 48 mg/dl for the high-glucose group. The corresponding rates of HE were 23.4 vs. 25.9 % (unadjusted p = 0.80; adjusted p = 0.08); PHE growth, 31.3 vs. 29.6 % (unadjusted p = 0.88; adjusted p = 0.39); and poor outcome at 3 months, defined as mRS score of ≥3, was 54 vs. 71 % (unadjusted p = 0.06; adjusted p = 0.89). On multivariate analyses, the ICH score emerged as the major predictor for poor outcome, but not glucose. In conclusion, we found a trend for an association between mean 72 h glucose levels and poor outcome at 3 months, but this effect attenuated after adjusting for the ICH score. High glucose was not associated with HE or PHE growth. More preclinical and clinical studies are needed to elucidate the role of hyperglycemia in ICH before embarking on large and costly clinical trials of tight glucose control in ICH patients.