Diabetic and stress-induced hyperglycemia in spontaneous intracerebral hemorrhage: A multicenter prospective cohort (CHEERY) study

Abstract

Introduction: Admission hyperglycemia is a common finding after spontaneous intracerebral hemorrhage (ICH) secondary to pre-existing diabetes mellitus (DM) or stress-induced hyperglycemia (SIH). Studies of the causal relationship between SIH and ICH outcomes are rare. Aim: We aimed to identify whether SIH or pre-existing DM was the cause of admission hyperglycemia associated with ICH outcomes. Methods: Admission glycosylated hemoglobin (HbA1c), glucose levels, and comorbidity data from the prospective, multicenter cohort, Chinese Cerebral Hemorrhage: Mechanisms and Intervention Study (CHEERY), were collected and analyzed. According to different admission blood glucose and HbA1c levels, patients were divided into nondiabetic normoglycemia (NDN), diabetic normoglycemia (DN), diabetic hyperglycemia (DH), and SIH groups. Modified Poisson regression models were used to analyze ICH outcomes in the different groups. Results: In total, 1372 patients were included: 388 patients with admission hyperglycemia, 239 with DH, and 149 with SIH. In patients with hyperglycemia, SIH was associated with a higher risk of pulmonary infection [risk ratios (RR): 1.477, 95% confidence interval (CI): 1.004–2.172], 30-day (RR: 1.068, 95% CI: 1.009–1.130) and 90-day mortality after ICH (RR: 1.060, 95% CI: 1.000–1.124). Conclusions: Admission hyperglycemia is a common finding after ICH, and SIH is a sensitive predictor of the risk of pulmonary infection and all-cause death after ICH.