Chang, J. J, Khorchid, Y., Kerro, A., Burgess, L. G, Goyal, N., Alexandrov, A. W, Alexandrov, A. V & Tsivgoulis, G. (2017). Sulfonylurea drug pretreatment and functional outcome in diabetic patients with acute intracerebral hemorrhage [accepted manuscript]. Journal of the Neurological Sciences,381 182-187. Retrieved from https://doi.org/http://dx.doi.org/10.1016/j.jns.2017.08.3252
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 in16% 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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