Symptomatic intracranial hemorrhage in patients with admission hyperglycemia and diabetes after mechanical thrombectomy: A systematic review and meta-analysis.

OBJECTIVES:Symptomatic intracranial hemorrhage (sICH) is a severe complication of revascularization therapy. We aimed to investigate the association of admission hyperglycemia and sICH after mechanical thrombectomy in patients with acute ischemic stroke. METHODS:We systematically searched PubMed, EMBASE and Cochrane Library to identify studies that reported incidence of sICH in patients with admission hyperglycemia and normoglycemia, or with and without a history of diabetes, or glucose level in patients with sICH and non-sICH from inception to December 10, 2019. The estimate effects were pooled by random-effects model. RESULTS:Twelve eligible studies were included with 4892 patients enrolled. The risk of sICH was significantly higher in admission hyperglycemia patients than that in normoglycemia (OR 2.93, 95% CI 1.34-6.42, p = 0.007; adjusted OR1.95, 95% CI 1.22-3.13; p = 0.006). The admission glucose level was significantly higher in sICH patients than that in non-sICH with a mean difference of 37.49 (95% CI 3.03-71.94, p = 0.03). The risk of sICH increased with elevating glucose level (adjusted OR 1.06, 95% CI 1.01-1.11; p = 0.02). The risk of sICH was not significantly increased in patients with a history of diabetes than that of those without (OR 1.74, 95% CI 1.00-3.03, p = 0.05; adjusted OR 2.26, 95% CI 0.97-5.28; p = 0.06). CONCLUSIONS:In patients of acute ischemic stroke treated with mechanical thrombectomy, the risk of sICH was associated with admission hyperglycemia but possibly not with a history of diabetes.