Association of Admission Hyperglycemia with Clinical Outcomes in Patients with Symptomatic Intracranial Hemorrhage After Endovascular Treatment for Large Vessel Occlusive Stroke

Jie Yan,1,&ast; Jiandi Huang,2,&ast; Tianqiang Pu,3,&ast; Jiaxing Song,2 Jie Yang,2 Linyu Li,2 Fengli Li,2 Wenjie Zi,2 Changwei Guo,2 Zhouzhou Peng2 1Department of Neurology, The First People’s Hospital of Yongzhou City, Yongzhou City, Hunan Province, People’s Republic of China; 2Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing City, People’s Republic of China; 3Department of Neurology, The Central Hospital of Guangyuan City, Guangyuan City, Sichuan Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhouzhou Peng; Changwei Guo, Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Shapingba District, Chongqing City, People’s Republic of China, Email peng_zhouzhou@163.com; changwei_guo@163.comBackground: Symptomatic intracranial hemorrhage (sICH) is a fatal complication after endovascular treatment (EVT) for acute large vessel occlusive (LVO) stroke. The aim of this study was to investigate the association between hyperglycemia and outcomes in patients with postprocedural sICH.Methods: Of the 2567 patients with AIS who underwent EVT from two large multicenter randomized trials and two prospective multicenter registry studies, 324 patients occurred sICH with documented admission glucose were included in this study. The primary outcome was functional independence (defined as a modified Rankin Scale score of 0 to 2) at 90 days. Secondary outcomes included mRS score of 0 to 3, 0 to 1, and mRS score at 90 days. Safety outcome was the mortality within 90 days. Admission hyperglycemia was defined as a plasma blood glucose ≥ 7.8 mmol/L (140 mg/dL) in our analysis.Results: Of 324 eligible participants included in this study, hyperglycemia was observed in 130 (40.1%) patients. The median age was 67 (IQR, 58– 75) years, and median blood glucose level was 7.1 (IQR, 6.0– 9.3) mmol/L. After adjusting for confounding variables, admission hyperglycemia was associated with decreased odds of functional independence (adjusted odds ratio[OR] 0.34; 95% CI 0.17– 0.68; P= 0.003), decreased odds of favorable outcome (adjusted OR 0.31; 95% CI 0.16– 0.58; P < 0.001) and increased odds of mortality (adjusted OR 2.56; 95% CI 1.47– 4.45; P = 0.001) at 90 days. After 1:1 propensity score matching analysis, the results were consistent with multivariable logistic regression analysis.Conclusion: In patients who suffered sICH after EVT for acute large vessel occlusive stroke, hyperglycemia is a strong predictor of poor clinical outcome and mortality at 90 days.Keywords: stroke, large vessel occlusion, endovascular treatment, symptomatic intracranial hemorrhage, hyperglycemia