title: Prognostic Significance of Hyperglycemia in Acute Intracerebral Hemorrhage: The INTERACT2 Study.
abstract: OBJECTIVE
  We aimed to determine associations of baseline blood glucose and diabetes mellitus with clinical outcomes in participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2).
  
  
  METHODS
  INTERACT2 was an international prospective, open, blinded end point, randomized controlled trial of 2839 patients with spontaneous intracerebral hemorrhage (<6 hours) and elevated systolic blood pressure randomly assigned to intensive (target systolic blood pressure <140 mm Hg) or guideline-based (systolic blood pressure <180 mm Hg) BP management. Associations of hyperglycemia at presentation (>6.5 mmol/L) and combined and separate poor outcomes of death and major disability (scores of 3-6, 3-5, and 6, respectively, on the modified Rankin scale) at 90 days were determined in logistic regression models.
  
  
  RESULTS
  In 2653 patients with available data, there were 1348 (61%) with hyperglycemia and 292 (11%) with diabetes mellitus. Associations of baseline blood glucose and poor outcome were strong and near continuous. After adjustment for baseline variables, the highest fourth (7.9-25.0 mmol/L) of blood glucose was significantly associated with combined poor outcome (adjusted odds ratio 1.35, 95% confidence interval 1.01-1.80; P trend 0.015). Diabetes mellitus also predicted poor outcome (adjusted odds ratio 1.46, 95% confidence interval 1.05-2.02; P=0.023), though more important for residual disability than death on separate analysis.
  
  
  CONCLUSIONS
  Hyperglycemia and diabetes mellitus are independent predictors of poor outcome in patients with predominantly mild to moderate severity of intracerebral hemorrhage. These data support guideline recommendations for good glycemic control in patients with intracerebral hemorrhage.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00716079.
authors.affiliation: From the The George Institute for Global Health, Royal Prince Alfred Hospital, Sydney, NSW, Australia (A.S., C.S.A., X.W., S.S., H.A., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Central Clinical School, University of Sydney, Sydney, Australia (A.S., C.S.A., X.W., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Japan (H.A.); Clínica Alemana de Santiago, Universidad del Desarrollo, Chile (P.M.-V., P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); CRCHUM, Département de Neurosciences, Université de Montréal, Montréal, QC, Canada (C.S.); Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile (P.M.L.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Anubhav
authors.initials: A
authors.lastname: Saxena
authors.affiliation: From the The George Institute for Global Health, Royal Prince Alfred Hospital, Sydney, NSW, Australia (A.S., C.S.A., X.W., S.S., H.A., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Central Clinical School, University of Sydney, Sydney, Australia (A.S., C.S.A., X.W., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Japan (H.A.); Clínica Alemana de Santiago, Universidad del Desarrollo, Chile (P.M.-V., P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); CRCHUM, Département de Neurosciences, Université de Montréal, Montréal, QC, Canada (C.S.); Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile (P.M.L.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.). canderson@george.org.au.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Anderson
authors.affiliation: From the The George Institute for Global Health, Royal Prince Alfred Hospital, Sydney, NSW, Australia (A.S., C.S.A., X.W., S.S., H.A., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Central Clinical School, University of Sydney, Sydney, Australia (A.S., C.S.A., X.W., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Japan (H.A.); Clínica Alemana de Santiago, Universidad del Desarrollo, Chile (P.M.-V., P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); CRCHUM, Département de Neurosciences, Université de Montréal, Montréal, QC, Canada (C.S.); Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile (P.M.L.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Xia
authors.initials: X
authors.lastname: Wang
authors.affiliation: From the The George Institute for Global Health, Royal Prince Alfred Hospital, Sydney, NSW, Australia (A.S., C.S.A., X.W., S.S., H.A., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Central Clinical School, University of Sydney, Sydney, Australia (A.S., C.S.A., X.W., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Japan (H.A.); Clínica Alemana de Santiago, Universidad del Desarrollo, Chile (P.M.-V., P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); CRCHUM, Département de Neurosciences, Université de Montréal, Montréal, QC, Canada (C.S.); Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile (P.M.L.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Sato
authors.affiliation: From the The George Institute for Global Health, Royal Prince Alfred Hospital, Sydney, NSW, Australia (A.S., C.S.A., X.W., S.S., H.A., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Central Clinical School, University of Sydney, Sydney, Australia (A.S., C.S.A., X.W., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Japan (H.A.); Clínica Alemana de Santiago, Universidad del Desarrollo, Chile (P.M.-V., P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); CRCHUM, Département de Neurosciences, Université de Montréal, Montréal, QC, Canada (C.S.); Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile (P.M.L.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Hisatomi
authors.initials: H
authors.lastname: Arima
authors.affiliation: From the The George Institute for Global Health, Royal Prince Alfred Hospital, Sydney, NSW, Australia (A.S., C.S.A., X.W., S.S., H.A., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Central Clinical School, University of Sydney, Sydney, Australia (A.S., C.S.A., X.W., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Japan (H.A.); Clínica Alemana de Santiago, Universidad del Desarrollo, Chile (P.M.-V., P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); CRCHUM, Département de Neurosciences, Université de Montréal, Montréal, QC, Canada (C.S.); Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile (P.M.L.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Edward
authors.initials: E
authors.lastname: Chan
authors.affiliation: From the The George Institute for Global Health, Royal Prince Alfred Hospital, Sydney, NSW, Australia (A.S., C.S.A., X.W., S.S., H.A., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Central Clinical School, University of Sydney, Sydney, Australia (A.S., C.S.A., X.W., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Japan (H.A.); Clínica Alemana de Santiago, Universidad del Desarrollo, Chile (P.M.-V., P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); CRCHUM, Département de Neurosciences, Université de Montréal, Montréal, QC, Canada (C.S.); Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile (P.M.L.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Paula
authors.initials: P
authors.lastname: Muñoz-Venturelli
authors.affiliation: From the The George Institute for Global Health, Royal Prince Alfred Hospital, Sydney, NSW, Australia (A.S., C.S.A., X.W., S.S., H.A., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Central Clinical School, University of Sydney, Sydney, Australia (A.S., C.S.A., X.W., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Japan (H.A.); Clínica Alemana de Santiago, Universidad del Desarrollo, Chile (P.M.-V., P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); CRCHUM, Département de Neurosciences, Université de Montréal, Montréal, QC, Canada (C.S.); Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile (P.M.L.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Candice
authors.initials: C
authors.lastname: Delcourt
authors.affiliation: From the The George Institute for Global Health, Royal Prince Alfred Hospital, Sydney, NSW, Australia (A.S., C.S.A., X.W., S.S., H.A., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Central Clinical School, University of Sydney, Sydney, Australia (A.S., C.S.A., X.W., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Japan (H.A.); Clínica Alemana de Santiago, Universidad del Desarrollo, Chile (P.M.-V., P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); CRCHUM, Département de Neurosciences, Université de Montréal, Montréal, QC, Canada (C.S.); Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile (P.M.L.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Thompson
authors.initials: T
authors.lastname: Robinson
authors.affiliation: From the The George Institute for Global Health, Royal Prince Alfred Hospital, Sydney, NSW, Australia (A.S., C.S.A., X.W., S.S., H.A., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Central Clinical School, University of Sydney, Sydney, Australia (A.S., C.S.A., X.W., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Japan (H.A.); Clínica Alemana de Santiago, Universidad del Desarrollo, Chile (P.M.-V., P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); CRCHUM, Département de Neurosciences, Université de Montréal, Montréal, QC, Canada (C.S.); Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile (P.M.L.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Christian
authors.initials: C
authors.lastname: Stapf
authors.affiliation: From the The George Institute for Global Health, Royal Prince Alfred Hospital, Sydney, NSW, Australia (A.S., C.S.A., X.W., S.S., H.A., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Central Clinical School, University of Sydney, Sydney, Australia (A.S., C.S.A., X.W., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Japan (H.A.); Clínica Alemana de Santiago, Universidad del Desarrollo, Chile (P.M.-V., P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); CRCHUM, Département de Neurosciences, Université de Montréal, Montréal, QC, Canada (C.S.); Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile (P.M.L.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Lavados
authors.affiliation: From the The George Institute for Global Health, Royal Prince Alfred Hospital, Sydney, NSW, Australia (A.S., C.S.A., X.W., S.S., H.A., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Central Clinical School, University of Sydney, Sydney, Australia (A.S., C.S.A., X.W., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Japan (H.A.); Clínica Alemana de Santiago, Universidad del Desarrollo, Chile (P.M.-V., P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); CRCHUM, Département de Neurosciences, Université de Montréal, Montréal, QC, Canada (C.S.); Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile (P.M.L.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Jiguang
authors.initials: J
authors.lastname: Wang
authors.affiliation: From the The George Institute for Global Health, Royal Prince Alfred Hospital, Sydney, NSW, Australia (A.S., C.S.A., X.W., S.S., H.A., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Central Clinical School, University of Sydney, Sydney, Australia (A.S., C.S.A., X.W., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Japan (H.A.); Clínica Alemana de Santiago, Universidad del Desarrollo, Chile (P.M.-V., P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); CRCHUM, Département de Neurosciences, Université de Montréal, Montréal, QC, Canada (C.S.); Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile (P.M.L.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Bruce
authors.initials: B
authors.lastname: Neal
authors.affiliation: From the The George Institute for Global Health, Royal Prince Alfred Hospital, Sydney, NSW, Australia (A.S., C.S.A., X.W., S.S., H.A., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Central Clinical School, University of Sydney, Sydney, Australia (A.S., C.S.A., X.W., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Japan (H.A.); Clínica Alemana de Santiago, Universidad del Desarrollo, Chile (P.M.-V., P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); CRCHUM, Département de Neurosciences, Université de Montréal, Montréal, QC, Canada (C.S.); Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile (P.M.L.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.affiliation: From the The George Institute for Global Health, Royal Prince Alfred Hospital, Sydney, NSW, Australia (A.S., C.S.A., X.W., S.S., H.A., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Central Clinical School, University of Sydney, Sydney, Australia (A.S., C.S.A., X.W., E.C., P.M.-V., C.D., B.N., J.C., E.H.); Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Japan (H.A.); Clínica Alemana de Santiago, Universidad del Desarrollo, Chile (P.M.-V., P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); CRCHUM, Département de Neurosciences, Université de Montréal, Montréal, QC, Canada (C.S.); Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile (P.M.L.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Emma
authors.initials: E
authors.lastname: Heeley
mesh_terms: D000208:Acute Disease; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002543:Cerebral Hemorrhage / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D038622:Internationality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016037:Single-Blind Method
chemical_list: D001786:Blood Glucose
keywords: clinical trial; death; diabetes mellitus; disability; hyperglycemia; outcome; prognosis