Diabetes and intracerebral hemorrhage: baseline characteristics and mortality

R Liebkind; D Gordin; D Strbian; A Meretoja; L M Thorn; S Hägg-Holmberg; C Forsblom; T Tatlisumak; P-H Groop; J Putaala

doi:10.1111/ene.13603

Diabetes and intracerebral hemorrhage: baseline characteristics and mortality

Eur J Neurol. 2018 Jun;25(6):825-832. doi: 10.1111/ene.13603. Epub 2018 Mar 26.

Authors

R Liebkind¹, D Gordin^{2

3

4

5}, D Strbian¹, A Meretoja^{1

6}, L M Thorn^{2

3

4}, S Hägg-Holmberg^{2

3

4}, C Forsblom^{2

3

4}, T Tatlisumak^{1

7}, P-H Groop^{2

3

4

8}, J Putaala¹

Affiliations

¹ Department of Neurology and Neurosciences, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
² Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
³ Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland.
⁴ Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
⁵ Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
⁶ Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.
⁷ Department of Clinical Neurosciences, Sahlgrenska Academy at the University of Gothenburg and Department of Neurology, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁸ Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia.

PMID: 29443444
DOI: 10.1111/ene.13603

Abstract

Background and purpose: Acknowledging the conflicting evidence for diabetes as a predictor of short- and long-term mortality following an intracerebral hemorrhage (ICH), we compared baseline characteristics and 30-day and long-term mortality between patients with and without diabetes after an ICH, paying special attention to differences between type 1 (T1D) and type 2 (T2D) diabetes.

Methods: Patients with a first-ever ICH were followed for a median of 2.3 years. Adjusting for demographics, comorbidities and documented ICH characteristics increasing mortality after ICH, logistic regression analysis assessed factors associated with case fatality and 1-year survival among the 30-day survivors. Diabetes was compared with patients without diabetes in separate models as (i) any diabetes and (ii) T1D or T2D.

Results: Of our 969 patients, 813 (83.9%) had no diabetes, 41 (4.2%) had T1D and 115 (11.9%) had T2D. Compared with patients without diabetes, those with diabetes were younger, more often men and more frequently had hypertension, coronary heart disease and chronic kidney disease, with similar ICH characteristics. Patients with T1D were younger, more often had chronic kidney disease and brainstem ICH, and less often had atrial fibrillation and lobar ICH, than did patients with T2D. Diabetes had no impact on case fatality. Any diabetes (odds ratio, 2.57; 1.19-5.52), T1D (odds ratio, 7.04; 1.14-43.48) and T2D (odds ratio, 2.32; 1.04-5.17) were independently associated with 1-year mortality.

Conclusions: Patients with ICH with diabetes exhibited a distinct pattern of comorbidities and disease characteristics with specific differences between T1D and T2D. Despite their younger age, T1D seems to carry a substantially higher likelihood of long-term mortality after an ICH than does T2D.

Keywords: diabetes; intracerebral hemorrhage; mortality; stroke; type 1 diabetes; type 2 diabetes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Atrial Fibrillation / mortality*
Cerebral Hemorrhage / mortality*
Comorbidity
Diabetes Complications / mortality*
Diabetes Mellitus / mortality*
Female
Humans
Hypertension / mortality*
Male
Middle Aged
Retrospective Studies
Risk Factors