Impact of Glucose Trajectories on Outcomes After Intracerebral Hemorrhage: The ATACH-2 trial

Impact of Glucose Trajectories on Outcomes After Intracerebral Hemorrhage: The ATACH-2 trial | medRxiv Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Impact of Glucose Trajectories on Outcomes After Intracerebral Hemorrhage: The ATACH-2 trial View ORCID Profile Mahmoud Fayed , View ORCID Profile Neha Saini , Sebastian Edwards , Cheng Zeng , Leo Duan , View ORCID Profile Amita Singh , Anna Khanna , Christina A. Wilson , View ORCID Profile Adnan I. Qureshi , View ORCID Profile Teng J. Peng doi: https://doi.org/10.64898/2026.03.12.26348296 Mahmoud Fayed 1 University of Florida, College of Medicine, Department of Neurology , Gainesville, FL, 32601 MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Mahmoud Fayed Neha Saini 1 University of Florida, College of Medicine, Department of Neurology , Gainesville, FL, 32601 MD, MPH Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Neha Saini Sebastian Edwards 1 University of Florida, College of Medicine, Department of Neurology , Gainesville, FL, 32601 DO, MS Find this author on Google Scholar Find this author on PubMed Search for this author on this site Cheng Zeng 2 University of Florida, Department of Biostatistics , Gainesville, FL, 32601 PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Leo Duan 2 University of Florida, Department of Biostatistics , Gainesville, FL, 32601 PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Amita Singh 1 University of Florida, College of Medicine, Department of Neurology , Gainesville, FL, 32601 MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Amita Singh Anna Khanna 1 University of Florida, College of Medicine, Department of Neurology , Gainesville, FL, 32601 MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Christina A. Wilson 1 University of Florida, College of Medicine, Department of Neurology , Gainesville, FL, 32601 MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Adnan I. Qureshi 3 Zeenat Qureshi Stroke Institute, Columbia, MO 65211; Department of Neurology, University of Missouri , Columbia, MO, 65212 MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Adnan I. Qureshi Teng J. Peng 1 University of Florida, College of Medicine, Department of Neurology , Gainesville, FL, 32601 MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Teng J. Peng For correspondence: Teng.Peng{at}neurology.ufl.edu Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Background Hyperglycemia after intracerebral hemorrhage (ICH) may be associated with worse outcomes. In this study, we evaluated the association of early post-ICH glucose trajectories and clinical outcomes. Methods We performed a secondary analysis of the ATACH-2 trial dataset. Hyperglycemia was defined as a blood glucose of ≥140 mg/dl. Glucose levels at 0h, 24h, 48h, and 72h were analyzed using a linear mixed effects model, with fixed effects for time and random intercept/slopes. Patient-specific estimates were used to predict glucose values at 0h and 72h, informed by all four timepoints, to classify patients into the following glycemic trajectory groups: (1) early hyperglycemia, (2) late hyperglycemia, (3) persistent hyperglycemia, and (4) persistent normoglycemia. Outcomes were compared using univariate analysis and log-rank test survival analysis. Good outcomes were defined as a modified Rankin Score of 0 to 2. The association between glycemic trajectories and functional outcomes was tested using logistic regression models adjusted for patient demographics and clinical variables. Results Of 1000 patients (median age 62 [IQR 52–71]; 38% female) in the study, 81 (8.1%) had early hyperglycemia, 59 (5.9%) late hyperglycemia, 225 (22.5%) persistent hyperglycemia, and 635 (63.5%) persistent normoglycemia. On univariate analysis, 45.8% of patients with persistent normoglycemia had favorable 90-day functional outcomes compared to 30.9% in early, 30.5% in late, and 32.0% in persistent hyperglycemia patients (p<0.001). The late hyperglycemia patients had the highest rate of hematoma expansion (35.3%, p=0.029) and the lowest Kaplan Meier-estimated survival (86%, p=0.015). In adjusted multivariable regression models, early hyperglycemia was significantly associated with a poor functional outcome (OR 2.27, 95% CI 1.10-4.68, p=0.026). Conclusion Early hyperglycemia was associated with worse functional outcomes, while late and persistent hyperglycemia were associated with worse survival rates. These findings suggest that glycemic trajectories may affect or predict prognosis. This highlights the importance of continuous glucose monitoring and glycemic control strategies after ICH. Competing Interest Statement Dr. Qureshi is a cofounder of DuQure, QureVasc, and QureMed and has received grant support from Chiesi USA. Dr. Duan is partially supported by the U.S. National Science Foundation under grant NSF-DMS 2319551. The other authors report no conflicts of interest Clinical Trial NCT01176565 Funding Statement No external funding was received Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was exempt from the UF IRB ET00049461 I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability ATACH-2 trial data was obtained from the NINDS biorepository Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. Back to top Previous Next Posted March 18, 2026. Download PDF Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. 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Peng medRxiv 2026.03.12.26348296; doi: https://doi.org/10.64898/2026.03.12.26348296 Share This Article: Copy Citation Tools Impact of Glucose Trajectories on Outcomes After Intracerebral Hemorrhage: The ATACH-2 trial Mahmoud Fayed , Neha Saini , Sebastian Edwards , Cheng Zeng , Leo Duan , Amita Singh , Anna Khanna , Christina A. Wilson , Adnan I. Qureshi , Teng J. 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