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

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Citation: Journal of the Neurological Sciences. 381:182-187, 2017 Oct 15PMID: 28991676Institution: MedStar Washington Hospital CenterDepartment: Critical Care MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Cerebral Hemorrhage/co [Complications] | *Cerebral Hemorrhage/dt [Drug Therapy] | *Diabetes Complications/dt [Drug Therapy] | *Sulfonylurea Compounds/ad [Administration & Dosage] | Acute Disease | Cerebral Hemorrhage/pa [Pathology] | Diabetes Complications/pa [Pathology] | Female | Humans | Linear Models | Logistic Models | Male | Middle Aged | Multivariate Analysis | Pilot Projects | Prospective Studies | Retrospective Studies | Severity of Illness Index | Treatment OutcomeYear: 2017ISSN:
  • 0022-510X
Name of journal: Journal of the neurological sciencesAbstract: 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. Copyright (c) 2017 Elsevier B.V. All rights reserved.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>18years. 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.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 NC<sub>Ca-ATP</sub> 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.RESULTS: 230 diabetic patients with acute ICH fulfilled inclusion criteria (mean age 64+/-13years, 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 (4cm<sup>3</sup>, IQR: 1-12) compared to controls [ICH-score: 1 (IQR: 0-3); HV: 9cm<sup>3</sup> (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.All authors: Alexandrov AV, Alexandrov AW, Burgess LG, Chang JJ, Goyal N, Kerro A, Khorchid Y, Tsivgoulis GFiscal year: FY2018Digital Object Identifier: Date added to catalog: 2017-10-17
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Journal Article MedStar Authors Catalog Article 28991676 Available 28991676

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. Copyright (c) 2017 Elsevier B.V. All rights reserved.

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>18years. 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.

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 NC<sub>Ca-ATP</sub> 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.

RESULTS: 230 diabetic patients with acute ICH fulfilled inclusion criteria (mean age 64+/-13years, 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 (4cm<sup>3</sup>, IQR: 1-12) compared to controls [ICH-score: 1 (IQR: 0-3); HV: 9cm<sup>3</sup> (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.

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