Acute hyperglycemia is associated with intraventricular extension among patients with spontaneous intracerebral hemorrhage

Alvin S Das; John W Erdman; Elizabeth C Heistand; Vasileios-Arsenios Lioutas; Corey R Fehnel; Jason Yoon; Sandeep Kumar; Robert W Regenhardt; M Edip Gurol; Long H Ngo; Bruno A Benitez; Magdy H Selim

doi:10.1016/j.jns.2024.123320

Acute hyperglycemia is associated with intraventricular extension among patients with spontaneous intracerebral hemorrhage

J Neurol Sci. 2024 Nov 22:467:123320. doi: 10.1016/j.jns.2024.123320. Online ahead of print.

Authors

Affiliations

¹ Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: adas4@bidmc.harvard.edu.
² Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: jerdman@bidmc.harvard.edu.
³ Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: eheistan@bidmc.harvard.edu.
⁴ Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: vlioutas@bidmc.harvard.edu.
⁵ Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: cfehnel@bidmc.harvard.edu.
⁶ Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: jyoon6@bidmc.harvard.edu.
⁷ Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: skumar@bidmc.harvard.edu.
⁸ Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: robert.regenhardt@mgh.harvard.edu.
⁹ Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: megurol@mgh.harvard.edu.
¹⁰ Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: lngo@bidmc.harvard.edu.
¹¹ Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: bbenitez@bidmc.harvard.edu.
¹² Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: mselim@bidmc.harvard.edu.

PMID: 39591672
DOI: 10.1016/j.jns.2024.123320

Abstract

Objective: Acute hyperglycemia following intracerebral hemorrhage (ICH) is associated with poor functional outcomes and may result from a neuroendocrine stress response. Given the proximity of neuroendocrine structures to the cerebral ventricles, we tested the hypothesis that intraventricular hemorrhage (IVH) is associated with hyperglycemia.

Materials and methods: A post-hoc analysis of the ICH Deferoxamine (i-DEF) trial was conducted to determine predictors of IVH. Variables with significant differences (p < 0.1) in univariable tests between patients with and without IVH were entered into a logistic regression model along with age, sex, diabetes, hyperglycemia (admission glucose ≥140 mg/dL), and baseline intraparenchymal hemorrhage (IPH) volume. This model was then applied to an independent cohort of consecutive non-traumatic ICH patients admitted to a single referral center (2007 to 2018).

Results: Among 294 patients in the i-DEF cohort with mean age 60 ± 12 years (IVH in 41 %), hyperglycemia (aOR 1.90, 95 % CI [1.06-3.38]), smoking history (aOR 1.90, 95 % CI [1.11-3.27]), and non-lobar ICH location (aOR 3.38, 95 % CI [1.49-7.69]) were independently associated with IVH. In the independent cohort consisting of 856 patients with mean age 71 ± 12 years (IVH in 37 %), hyperglycemia (aOR 2.23, 95 % CI [1.55-3.20]), non-lobar ICH location (aOR 2.50, 95 % CI [1.75-3.59]), and IPH volume (aOR 1.02, 95 % CI [1.01-1.02]) were associated with IVH.

Conclusions: Hyperglycemia is associated with IVH and may be a peripheral marker for the inflammatory response to hemorrhage within the ventricles. Further translational studies are needed to elucidate the pathophysiological basis for this phenomenon.

Keywords: Cerebral hemorrhage; Glucose; Hyperglycemia; Intraventricular hemorrhage.