Impact of Glucose Trajectories on Outcomes in Intracerebral Hemorrhage Patients

Purpose Hyperglycemia after intracerebral hemorrhage (ICH) may be associated with worse outcomes. In this study, we evaluated the association of early post‐ICH glucose trajectories and clinical outcomes. Materials and Methods We performed a secondary analysis of the ATACH‐2 trial dataset. Hyperglycemia was defined as a blood glucose of ≥140 mg/dl. Glucose levels at 0h, 24h, 48h, and 72h were analyzed using a linear mixed effects model, with fixed effects for time and random intercept/slopes. Patient‐specific estimates were used to predict glucose values at 0h and 72h, informed by all four timepoints, to classify patients into the following glycemic trajectory groups: (1) early hyperglycemia, (2) late hyperglycemia, (3) persistent hyperglycemia, and (4) persistent normoglycemia. Outcomes were compared using univariate analysis and log‐rank test survival analysis. Good outcomes were defined as a modified Rankin Score of 0 to 2. The association between glycemic trajectories and functional outcomes was tested using logistic regression models adjusted for age, sex, race, medical comorbidities, treatment arm, presence of IVH, ICH volume, and initial National Institutes of Health Stroke Scale (NIHSS) and GCS scores. Results Of 1000 patients (median age 62 [IQR 52–71]; 38% female), 81 (8.1%) patients had early hyperglycemia, 59 (5.9%) late hyperglycemia, 225 (22.5%) persistent hyperglycemia, and 635 (63.5%) persistent normoglycemia. On univariate analysis, 45.8% of patients with persistent normoglycemia had favorable 90‐day functional outcomes compared to 30.9% in early, 30.5% in late, and 32.0% in persistent hyperglycemia patients (p<0.001). The late hyperglycemia patients had the highest rate of ICH expansion (35.3%, p=0.029) and the lowest Kaplan Meier‐estimated survival (86%, p=0.015). In adjusted multivariable regression models, early hyperglycemia was significantly associated with a poor functional outcome (OR 2.62, 95% CI 1.31–5.25, p<0.006). Conclusion Persistent and late hyperglycemia were associated with worse functional outcomes and higher mortality rates. These findings suggest that glycemic trajectories, not only admission glucose, may affect prognosis. This highlights the importance of continuous glucose monitoring and glycemic control strategies after ICH.