Impact of type 2 diabetes mellitus on hematoma expansion and clinical outcomes in patients with spontaneous intracranial hematoma

TL;DR

This study finds that type 2 diabetes increases the risk of hematoma expansion and mortality in patients with brain hemorrhage, but does not worsen long-term functional recovery.

Contribution

The study provides new evidence on the specific impact of type 2 diabetes on hematoma expansion and mortality in spontaneous intracerebral hemorrhage patients.

Findings

Type 2 diabetes significantly increases the risk of hematoma expansion in sICH patients.

Diabetic patients had higher all-cause mortality at 1, 3, and 6 months post-sICH.

Diabetes did not significantly affect functional outcomes at 1, 3, or 6 months post-sICH.

Abstract

Spontaneous intracerebral hemorrhage (sICH) significantly affects patient outcomes. Diabetes mellitus (DM) is a common comorbidity associated with sICH; however, the influence of DM on hematoma expansion (HE) and clinical prognosis in sICH patients remains a subject of debate.

This multicenter retrospective study included sICH patients who visited the neurosurgery departments of eight hospitals between 1 January 2015 and 31 May 2021. These patients were followed up for 6 months post-sICH and divided into two groups: those with type 2 DM (DM group) and those with no diabetes mellitus (nDM group). The chi-square test, Mann–Whitney U test, and multivariate logistic regression analysis were employed to evaluate the impact of DM on HE and patient outcomes.

A total of 1,453 patients were admitted to the eight hospitals between 1 January 2015 and 31 May 2021. A total of 1,134 sICH patients were ultimately included in this study for further analysis, based on the inclusion and exclusion criteria. Of these, 182 (16.0%) patients were assigned to the DM group, while 952 (84.0%) patients were assigned to the nDM group. In the intergroup comparison, significant differences were observed in terms of gender, age, smoking, hypertension, coronary heart disease, antiplatelet therapy, ventricular hematoma, and heterogeneous hematoma density. After adjusting for the above confounders, DM was found to significantly increase the incidence of HE (3.552, 95% CI: 2.342–5.387, p = 0.000). Similarly, DM significantly increased all-cause mortality at 1 month (1.965, 95% CI: 1.006–3.840, p = 0.048), 3 months (1.980, 95% CI: 1.071–3.662, p = 0.029), and 6 months (1.776, 95% CI: 1.034–3.050, p = 0.038) in sICH patients. However, DM did not worsen functional prognosis in patients with sICH at 1 month (1.363, 95% CI: 0.909–2.043, p = 0.134), 3 months (1.124, 95% CI: 0.746–1.692, p = 0.577), and 6 months (1.177, 95% CI: 0.789–1.754, p = 0.425), after adjusting for confounding factors.

DM is a risk factor for HE and all-cause mortality at 1, 3, and 6 months post-sICH. However, DM does not significantly worsen the functional prognosis of sICH patients at 1, 3, and 6 months.

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