Acute hyperglycemia after intracerebral hemorrhage is associated with 90-day cognitive impairment

Admission hyperglycemia (glucose > 140 mg/dL) after ischemic stroke is associated with poor clinical outcomes, including cognitive impairment. Although hyperglycemia is commonly observed following intracerebral hemorrhage (ICH), it remains unclear whether its presence is also associated with reduced cognitive performance.

In this post hoc analysis of the ICH Deferoxamine Trial, admission hyperglycemia and other baseline characteristics were compared between patients with and without cognitive impairment (90-day Montreal Cognitive Assessment score < 26) using univariable and multivariable models.

Among 293 patients with spontaneous, supratentorial ICH (aged 60±12 years, 38% female), 132 had hyperglycemia and 134 met criteria for cognitive impairment. Patients with cognitive impairment were older (61±12 vs. 57±11 years, p = 0.02), more likely to be female (46% vs. 28%, p = 0.02), had less coronary artery disease (6% vs. 16%, p = 0.06), higher hemorrhage volumes (19.5 mL [IQR 9.3-32.7] vs. 12.2 mL [IQR 6.1-18.3], p < 0.01), and more lobar hemorrhages (25% vs. 13%, p = 0.05). When these variables were entered into a multivariable logistic regression model, age (aOR 1.04, 95% CI [1.01-1.07]), coronary artery disease (aOR 0.33, 95% CI [0.11-0.97]), hyperglycemia (aOR 2.03, 95% CI [1.03-3.97]), and ICH volume (aOR 1.03, 95% CI [1.01-1.06]) were independently associated with impaired cognition.

The association between admission hyperglycemia and cognition indicates that acute hyperglycemia may identify patients at heightened risk of cognitive decline, underscoring the need for further studies to determine whether aggressive glycemic control mitigates post-ICH cognitive impairment.