Article Commentary: “Effect of Moderate and Severe Persistent Hyperglycemia on Outcomes in Patients With Intracerebral Hemorrhage”
Ayush Agarwal, MD, DM, DNB
@drayushagarwal
The optimal management of hyperglycaemia in ICH continues to be a grey area with precise guidelines yet to be framed. This multi centric study sought to answer this query and evaluated the effect of persistent hyperglycaemia on the 90-day functional outcome (mRS) in patients with ICH, enrolled within 4.5 hours of symptom onset with hematomas<60ml and GCS>5. Moderate hyperglycaemia was defined as serum glucose concentrations between 140-180mg/dl and severe hyperglycaemia as beyond 180mg/dl. Blood sugar monitoring was done for 3 days (upon admission and successively at 24, 48 and 72 hours).
The study found that moderate and severe persistent hyperglycaemia was associated with statistically significant worse outcomes (higher 90-day death or disability). These were mirrored in non-diabetic patients with ICH. However, statistical significance was not attained in the previously diagnosed diabetic group. The calculated risk was adjusted for Glasgow coma scale score, hematoma volume, intraventricular hemorrhage, hypertension, hyperlipidemia and cigarette smoking to rule out potential bias and confounding. No glycemic association with hematoma expansion was found.