Elsevier

World Neurosurgery

Volume 114, June 2018, Pages e756-e765
World Neurosurgery

Original Article
Association Between Blood Glucose and Functional Outcome in Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

https://doi.org/10.1016/j.wneu.2018.03.077Get rights and content

Highlights

  • This meta-analysis evaluated published studies on the association between blood glucose level and functional outcome in patients with intracerebral hemorrhage.

  • High blood glucose level is significantly associated with poor functional outcome.

Background

Intracerebral hemorrhage (ICH) is a devastating subtype of stroke. Patients with ICH have poor functional outcomes. The association between blood glucose level and functional outcome in ICH remains unclear. This systematic review and meta-analysis aimed to investigate the association between blood glucose level and functional outcomes in patients with ICH.

Methods

Literature was searched systemically in PubMed, EMBASE, Web of Science, and Cochrane Library. Published cohort studies evaluating the association between blood glucose and functional outcome in patients with ICH were included. This meta-analysis was performed using odds ratios (ORs) and 95% confidence intervals (CIs).

Results

A total of 16 studies were included in our meta-analysis. Our data show that hyperglycemia defined by cutoff values was significantly associated with unfavorable functional outcome (OR, 1.80; 95% CI, 1.36–2.39; P < 0.001). Our analysis also suggested a significant association between increased blood glucose levels and functional outcomes (OR, 1.05; 95% CI, 1.03–1.07; P < 0.001).

Conclusions

High blood glucose level is significantly associated with poor functional outcome in ICH. Further studies with larger sample sizes, more time points, and longer follow-up times are necessary to confirm this association.

Introduction

Intracerebral hemorrhage (ICH) is a devastating subtype of stroke that accounts for approximately 10%–20% of all stroke cases.1 Although the management of ICH has improved in recent decades, ICH remains associated with ave high mortality and poor functional outcome.2 Previous studies have shown that high blood glucose levels could have a biologically plausible association with poor outcomes in patients with ICH. A high blood glucose level is related to brain edema and neuronal apoptosis in ICH.3 Hyperglycemia is also reported to cause severe blood–brain barrier destruction via down-regulation of aquaporin-4.4 Previous studies have suggested an association between hyperglycemia and mortality in patients with ICH.5, 6 One meta-analysis also reported that hyperglycemia could increase short-term and long-term mortality in patients with ICH.7 The association between blood glucose level and functional outcomes in patients with ICH is still unclear, however. Although previous studies have examined the effect of blood glucose level on functional outcome in patients with ICH, the results have been inconsistent.8, 9 Thus, we performed this systematic review and meta-analysis to investigate the association between blood glucose level and functional outcome in patients with ICH.

Section snippets

Search Strategy

We performed our systematic review and meta-analysis following using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.10 Related literature was systematically obtained in searches of PubMed, EMBASE, Web of Science, and the Cochrane Library on September 30, 2017. Our search strategy included the following keywords: (“intracerebral hemorrhage” or “cerebral hemorrhage” or “intracerebral haemorrhage” or “cerebral haemorrhage” or “brain haemorrhage” or

Study Characteristics

A total of 16 studies published between 2010 and 2017 were included in this systematic review and meta-analysis (Figure 1). In these 16 studies, the sample size ranged from 40 to 2951. Eight studies8, 9, 16, 17, 18, 19, 20, 21 used cutoff values to define hyperglycemia, 7 studies22, 23, 24, 25, 26, 27, 28 evaluated blood glucose level as a continuous variable, and another study29 analyzed blood glucose using cutoff values and a continuous variable approach. The cutoff values used to define

Discussion

This systematic review and meta-analysis was performed to investigate the association between blood glucose level and functional outcome in patients with ICH. Finally, 9 studies were included in the meta-analysis of hyperglycemia defined by cutoff values, and 8 studies were included in the meta-analysis of increase of blood glucose. The results suggest that hyperglycemia defined by cutoff values was significantly associated with poor functional outcome in patients with ICH. An increase in blood

Conclusions

In conclusion, this systematic review and meta-analysis suggested a significant association between high blood glucose level and poor functional outcome in patients with ICH. Further studies with larger sample sizes, more time points, and longer follow-up times are necessary to confirm the association between blood glucose level and functional outcome in ICH.

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    Conflict of interest statement: This work was supported by Support Project Funding of the Science and Technology Department of Sichuan Province (Grant 2014SZ0043).

    Jun Zheng, Zhiyuan Yu, and Lu Ma contributed equally to this work and should be considered co–first authors.

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