Diabetes Is an Independent Risk Factor for In-Hospital Mortality From Acute Spontaneous Intracerebral Hemorrhage
OBJECTIVE -- We tested the hypothesis that diabetes is an independent determinant of outcome after intracerebral hemorrhage (ICH).
RESEARCH DESIGN AND METHODS -- This was a hospital-based prospective study. The setting was an acute care 350-bed hospital in the city of Barcelona, Spain. Spontaneous ICH was diagnosed in 229 (11%) of 2,000 consecutive stroke patients included in a prospective stroke registry during a 10-year period. Main outcome measures were frequency of demographic variables, risk factors, clinical events, neuroimaging data, and outcome in ICH patients with and without diabetes. Variables related to vital status at discharge (alive or dead) in the univariate analysis plus age were studied in 4 logistical regression models.
RESULTS -- A total of 35 patients (15.3%) had diabetes. The overall in-hospital mortality rate was 54.3% in the diabetic group and 26.3% in the nondiabetic group (P [less than] 0.001). Previous cerebral infarction, altered consciousness, sensory symptoms, cranial nerve palsy, multiple topography of the hematoma, intraventricular hemorrhage, and infections complications were significantly more frequent in diabetic patients than in nondiabetic patients. The presence of diabetes was a significant predictive variable in the model based on demographic variables and cardiovascular risk factors (odds ratio 2.98 [95% CI 1.37-6.46]) and in the models based on these variables plus clinical variables (5.76 [2.01-16.51]), neuroimaging variables (5.59 [1.87-16.69]), and outcome data (6.10 [2.04-18.29]).
CONCLUSIONS -- Diabetes is an independent determinant of death after ICH. ICH in diabetic individuals presents some different clinical features compared with ICH in nondiabetic patients.
Acute spontaneous intracerebral hemorrhage (ICH) is a serious disease with high mortality and morbidity [1-3]. Multivariate studies that have investigated 30-day mortality after ICH have shown that the level of consciousness, size of the hematoma, ventricular extension, limb paresis, and communication disorders are independent predictors of death [4-10]. In a recent study, the age of the patient and the amount of alcohol consumed within 1 week of the ICH seemed to be independent determinants of outcome after ICH . However, besides the severity of hemorrhage, a few studies have analyzed the influence of preictal factors on the outcome of ICH. Whether diabetes (which increases mortality in ischemic stroke) , other vascular risk factors, or previous or concomitant pathological conditions influence the outcome is unknown. Experimental studies have demonstrated that a zone of ischemia surrounds the hematoma, which is maximal when uncontained and when large volumes of blood are involved . Hyperglycemia in the acute phase of stroke has been established as a predictor of poor outcome in nondiabetic patients. Because both acute and chronic hyperglycemia are associated with increased edema and infarct size and with reduced cerebral blood flow and cerebrovascular reserve , one may postulate that diabetes may also increase ischemic brain damage around an ICH and therefore emerge as a clinical predictor of worse prognosis in ICH patients. The aim of this study was to determine the influence of diabetes on in-hospital mortality in a cohort of 229 consecutive ICH patients in a prospective stroke registry. Subjects with diabetes diagnosed before...
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