Stress-Induced Hyperglycemia and Remote Diffusion-Weighted Imaging Lesions in Primary Intracerebral Hemorrhage.

Abstract

BACKGROUND AND PURPOSE:

Stress-induced hyperglycemia (SIH) is the relative transient increase in glucose during a critical illness such as intracerebral hemorrhage (ICH) and is likely to play an important role in the pathogenesis of remote diffusion-weighted imaging (DWI) lesion (R-DWIL) in primary ICH. We sought to determine the association between SIH and the occurrence of R-DWILs.

METHODS:

We prospectively enrolled primary ICH patients within 14 days after onset from November 2016 to May 2018. In these patients, cerebral magnetic resonance imaging was performed within 14 days after ICH onset. R-DWIL was defined as a hyperintensity signal in DWI with corresponding hypointensity in apparent diffusion coefficient, and at least 20 mm apart from the hematoma. SIH was measured by stress-induced hyperglycemia ratio (SHR). SHR was calculated by fasting blood glucose (FBG) divided by estimated average glucose derived from glycosylated hemoglobin. The included patients were dichotomized into two groups by the 50th percentile of SHR, and named as SHR (-P50) group and SHR (P50+) group, respectively. We evaluated the association between SHR and R-DWIL occurrence using multivariable logistic regression modeling adjusted for potential confounders.

RESULTS:

Among the 288 patients enrolled, forty-six (16.0%) of them had one or more R-DWILs. Compared with the patients in the lower 50% of SHR (SHR [-P50]), the odds ratio (OR) [95% confidence interval (CI)] for the higher 50% of SHR (SHR [P50+]) group for R-DWIL occurrence was 3.13 (1.39-7.07) in the total population and 6.33 (2.19-18.30) in population absent of background hyperglycemia after adjusting for potential covariates. Similar results were observed after further adjusted for FBG.

CONCLUSIONS:

Our study demonstrated that SIH was associated with the occurrence of R-DWILs in patients with primary ICH within 14 days of symptom onset.

• Authors: Xiang-Hua Ye, Xue-Li Cai, Dong-Liang Nie, Ye-Jun Chen, Jia-Wen Li, Xu-Hua Xu, Jin-Song Cai, Zhi-Rong Liu, Xin-Zhen Yin, Shui-Jiang Song, Lu-Sha Tong, Feng Gao
• Journal: Neurocritical care (Neurocrit Care) Vol. 32 Issue 2 Pg. 427-436 (04 2020) ISSN: 1556-0961 [Electronic] United States
• PMID: 31313140 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Blood Glucose
• Glycated Hemoglobin A
• hemoglobin A1c protein, human

Topics

• Aged
• Blood Glucose (metabolism)
• Brain (diagnostic imaging)
• Brain Diseases (diagnostic imaging, epidemiology)
• Cerebral Hemorrhage (complications, diagnostic imaging)
• Diffusion Magnetic Resonance Imaging
• Female
• Glycated Hemoglobin (metabolism)
• Humans
• Hyperglycemia (epidemiology, etiology, metabolism)
• Logistic Models
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Multivariate Analysis
• Stress, Physiological
• Tomography, X-Ray Computed