Hyperglycemia Is Associated with Intraventricular Extension Among Patients with Spontaneous Intracerebral Hemorrhage
Alvin Das1, Elizabeth Heistand1, Robert Regenhardt2, Corey Fehnel1, Jennifer Dearborn-Tomazos1, Vasileios-Arsenios Lioutas1, Sandeep Kumar1, Magdy Selim1
1Department of Neurology, Beth Israel Deaconess Medical Center, 2Department of Neurology, Massachusetts General Hospital
Objective:
We aimed to evaluate whether elevated serum glucose is associated with intraventricular extension in patients with intracerebral hemorrhage.
Background:
Stress hyperglycemia is a common finding in spontaneous intracerebral hemorrhage that may be associated with poor outcome. Intraventricular extension is also associated with poor prognosis among patients with intracerebral hemorrhage. Whether intraventricular extension is associated with hyperglycemia is currently unknown.
Design/Methods:
Demographic information, risk factors, and laboratory values including admission serum glucose levels were collected from a prospective database of consecutive non-traumatic ICH patients admitted to a single referral center between 2007 to 2018. Hemorrhage volumes were calculated from baseline computed tomography (CT) scans using the ABC/2 formula, and CT scans were reviewed for the presence of intraventricular extension. Serum glucose values on admission were compared between patients with and without intraventricular extension in univariate and multivariate models.
Results:
856 patients with spontaneous intracerebral hemorrhage were included in the analysis. The mean age of the cohort was 71±15 years and the proportion of females was 44%. The mean hemorrhage volume was 32.7±40.6 mL, and intraventricular extension occurred in 318 (37%) patients. Among those with intraventricular extension, the average admission glucose was 159.7±74.1 mg/dL compared to 135.5±56.7 mg/dL (p = 0.01) in those without intraventricular hemorrhage. In a multivariable regression model, admission serum glucose (aOR 1.01, 95% CI (1.00–1.01), p < 0.01) was independently associated with intraventricular extension after adjusting for age, sex, hypertension, diabetes, and hemorrhage volume.
Conclusions:
Admission serum glucose is associated with intraventricular extension among patients with spontaneous intracerebral hemorrhage. Such findings may reflect a stress response that occurs due to the presence of blood products within the ventricles. While further studies are needed to further elucidate the pathophysiological basis for this phenomenon, elevated serum glucose may be a reliable peripheral marker for intraventricular extension.