Sulfonylurea drug pretreatment and functional outcome in diabetic patients with acute intracerebral hemorrhage

Jason J. Chang, Yasser Khorchid, Ali Kerro, L. Goodwin Burgess, Nitin Goyal, Anne Alexandrov, Andrei Alexandrov, Georgios Tsivgoulis

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Abstract

Purpose Intracerebral hemorrhage (ICH) is associated with poor clinical outcome and high mortality. Sulfonylurea (SFU) use may be a viable therapy for inhibiting sulfonylurea receptor-1 and NCCa-ATP channels and reducing perihematomal edema and blood-brain barrier disruption. We sought to evaluate the effects of prehospital SFU use with outcomes in diabetic patients with acute ICH. Methods We retrospectively analyzed a cohort of diabetic patients presenting with acute ICH at a tertiary care center. Study inclusion criteria included spontaneous ICH etiology and age > 18 years. Baseline clinical severity was documented using ICH-score. Hematoma volumes (HV) on admission were calculated using ABC/2 formula. Unfavorable functional outcome was documented as discharge modified Rankin Scale scores 2–6. Results 230 diabetic patients with acute ICH fulfilled inclusion criteria (mean age 64 ± 13 years, men 53%). SFU pretreatment was documented in 16% of the study population. Patients with SFU pretreatment had significantly (p < 0.05) lower median ICH-scores (0, IQR: 0–2) and median admission HV (4cm3, IQR: 1–12) compared to controls [ICH-score: 1 (IQR: 0–3); HV: 9cm3 (IQR: 3–20)]. SFU pretreatment was independently (p = 0.033) and negatively associated with the cubed root of admission HV (linear regression coefficient: − 0.208; 95%CI: − 0.398 to − 0.017) in multiple linear regression analyses adjusting for potential confounders. Pretreatment with SFU was also independently (p = 0.033) associated with lower likelihood of unfavorable functional outcome (OR = 0.19; 95%CI: 0.04–0.88) in multivariable logistic regression models adjusting for potential confounders. Conclusion SFU pretreatment may be an independent predictor for improved functional outcome in diabetic patients with acute ICH. This association requires independent confirmation in a large prospective cohort study.

Original languageEnglish (US)
Pages (from-to)182-187
Number of pages6
JournalJournal of the Neurological Sciences
Volume381
DOIs
StatePublished - Oct 15 2017

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Cerebral Hemorrhage
Pharmaceutical Preparations
Hematoma
Linear Models
Logistic Models
Sulfonylurea Receptors
Blood-Brain Barrier
Tertiary Care Centers
Edema
Cohort Studies
Adenosine Triphosphate
Regression Analysis
Prospective Studies
Mortality

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

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Sulfonylurea drug pretreatment and functional outcome in diabetic patients with acute intracerebral hemorrhage. / Chang, Jason J.; Khorchid, Yasser; Kerro, Ali; Burgess, L. Goodwin; Goyal, Nitin; Alexandrov, Anne; Alexandrov, Andrei; Tsivgoulis, Georgios.

In: Journal of the Neurological Sciences, Vol. 381, 15.10.2017, p. 182-187.

Research output: Contribution to journalArticle

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title = "Sulfonylurea drug pretreatment and functional outcome in diabetic patients with acute intracerebral hemorrhage",
abstract = "Purpose Intracerebral hemorrhage (ICH) is associated with poor clinical outcome and high mortality. Sulfonylurea (SFU) use may be a viable therapy for inhibiting sulfonylurea receptor-1 and NCCa-ATP channels and reducing perihematomal edema and blood-brain barrier disruption. We sought to evaluate the effects of prehospital SFU use with outcomes in diabetic patients with acute ICH. Methods We retrospectively analyzed a cohort of diabetic patients presenting with acute ICH at a tertiary care center. Study inclusion criteria included spontaneous ICH etiology and age > 18 years. Baseline clinical severity was documented using ICH-score. Hematoma volumes (HV) on admission were calculated using ABC/2 formula. Unfavorable functional outcome was documented as discharge modified Rankin Scale scores 2–6. Results 230 diabetic patients with acute ICH fulfilled inclusion criteria (mean age 64 ± 13 years, men 53{\%}). SFU pretreatment was documented in 16{\%} of the study population. Patients with SFU pretreatment had significantly (p < 0.05) lower median ICH-scores (0, IQR: 0–2) and median admission HV (4cm3, IQR: 1–12) compared to controls [ICH-score: 1 (IQR: 0–3); HV: 9cm3 (IQR: 3–20)]. SFU pretreatment was independently (p = 0.033) and negatively associated with the cubed root of admission HV (linear regression coefficient: − 0.208; 95{\%}CI: − 0.398 to − 0.017) in multiple linear regression analyses adjusting for potential confounders. Pretreatment with SFU was also independently (p = 0.033) associated with lower likelihood of unfavorable functional outcome (OR = 0.19; 95{\%}CI: 0.04–0.88) in multivariable logistic regression models adjusting for potential confounders. Conclusion SFU pretreatment may be an independent predictor for improved functional outcome in diabetic patients with acute ICH. This association requires independent confirmation in a large prospective cohort study.",
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T1 - Sulfonylurea drug pretreatment and functional outcome in diabetic patients with acute intracerebral hemorrhage

AU - Chang, Jason J.

AU - Khorchid, Yasser

AU - Kerro, Ali

AU - Burgess, L. Goodwin

AU - Goyal, Nitin

AU - Alexandrov, Anne

AU - Alexandrov, Andrei

AU - Tsivgoulis, Georgios

PY - 2017/10/15

Y1 - 2017/10/15

N2 - Purpose Intracerebral hemorrhage (ICH) is associated with poor clinical outcome and high mortality. Sulfonylurea (SFU) use may be a viable therapy for inhibiting sulfonylurea receptor-1 and NCCa-ATP channels and reducing perihematomal edema and blood-brain barrier disruption. We sought to evaluate the effects of prehospital SFU use with outcomes in diabetic patients with acute ICH. Methods We retrospectively analyzed a cohort of diabetic patients presenting with acute ICH at a tertiary care center. Study inclusion criteria included spontaneous ICH etiology and age > 18 years. Baseline clinical severity was documented using ICH-score. Hematoma volumes (HV) on admission were calculated using ABC/2 formula. Unfavorable functional outcome was documented as discharge modified Rankin Scale scores 2–6. Results 230 diabetic patients with acute ICH fulfilled inclusion criteria (mean age 64 ± 13 years, men 53%). SFU pretreatment was documented in 16% of the study population. Patients with SFU pretreatment had significantly (p < 0.05) lower median ICH-scores (0, IQR: 0–2) and median admission HV (4cm3, IQR: 1–12) compared to controls [ICH-score: 1 (IQR: 0–3); HV: 9cm3 (IQR: 3–20)]. SFU pretreatment was independently (p = 0.033) and negatively associated with the cubed root of admission HV (linear regression coefficient: − 0.208; 95%CI: − 0.398 to − 0.017) in multiple linear regression analyses adjusting for potential confounders. Pretreatment with SFU was also independently (p = 0.033) associated with lower likelihood of unfavorable functional outcome (OR = 0.19; 95%CI: 0.04–0.88) in multivariable logistic regression models adjusting for potential confounders. Conclusion SFU pretreatment may be an independent predictor for improved functional outcome in diabetic patients with acute ICH. This association requires independent confirmation in a large prospective cohort study.

AB - Purpose Intracerebral hemorrhage (ICH) is associated with poor clinical outcome and high mortality. Sulfonylurea (SFU) use may be a viable therapy for inhibiting sulfonylurea receptor-1 and NCCa-ATP channels and reducing perihematomal edema and blood-brain barrier disruption. We sought to evaluate the effects of prehospital SFU use with outcomes in diabetic patients with acute ICH. Methods We retrospectively analyzed a cohort of diabetic patients presenting with acute ICH at a tertiary care center. Study inclusion criteria included spontaneous ICH etiology and age > 18 years. Baseline clinical severity was documented using ICH-score. Hematoma volumes (HV) on admission were calculated using ABC/2 formula. Unfavorable functional outcome was documented as discharge modified Rankin Scale scores 2–6. Results 230 diabetic patients with acute ICH fulfilled inclusion criteria (mean age 64 ± 13 years, men 53%). SFU pretreatment was documented in 16% of the study population. Patients with SFU pretreatment had significantly (p < 0.05) lower median ICH-scores (0, IQR: 0–2) and median admission HV (4cm3, IQR: 1–12) compared to controls [ICH-score: 1 (IQR: 0–3); HV: 9cm3 (IQR: 3–20)]. SFU pretreatment was independently (p = 0.033) and negatively associated with the cubed root of admission HV (linear regression coefficient: − 0.208; 95%CI: − 0.398 to − 0.017) in multiple linear regression analyses adjusting for potential confounders. Pretreatment with SFU was also independently (p = 0.033) associated with lower likelihood of unfavorable functional outcome (OR = 0.19; 95%CI: 0.04–0.88) in multivariable logistic regression models adjusting for potential confounders. Conclusion SFU pretreatment may be an independent predictor for improved functional outcome in diabetic patients with acute ICH. This association requires independent confirmation in a large prospective cohort study.

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