Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
Stress Hyperglycemia is Predictive of Clinical Outcomes in Patients with Spontaneous Intracerebral Hemorrhage
First author：Li Sijia
Corresponding author：Zhao Xingquan
essential_information
- Person in charge：Li Sijia
- Data Sources：
- Number of papers：脑出血登记20210131
- Published time：2022-06-27
2022-06-27
Published articles
Journal：BMC Neurology
Publication type: Article
IF(IF): 2.903
PMID: 35761206 Link To Pubmed Full text Download
Background And Purpose
Patients with spontaneous intracerebral hemorrhage (ICH) have high mortality and morbidity rates all over the world. Stress hyperglycemia is common after an acute illness such as acute myocardial infarction, severe traumatic brain Injury or stroke, especially in patients without diabetes. Many studies have illustrated that stress hyperglycemia could be a prognostic factor of mortality or poor functional outcome after intracerebral hemorrhage. Furthermore, in most previous literature, stress hyperglycemia was defined as the absolute increase of fasting blood glucose (FBG) or random blood glucose (RBG) without taking background glycemic status into consideration. Recently, studies revealed that relative hyperglycemia, presented with glucose/HbA1c ratio, could better predict the poor prognosis after critical illness than absolute hyperglycemia. However, there is little data about the role of stress hyperglycemia, defined as glucose/HbA1c ratio on outcome after intracerebral hemorrhage. Therefore, in this study, we aim to disclose the relationship between stress hyperglycemia, measured by glucose/HbA1c ratio and clinical outcomes in patients with spontaneous intracerebral hemorrhage.
Method
A sample of eligible 586 patients with spontaneous intracerebral hemorrhage from a multicenter, hospital-based cohort between 2014 and 2016 were recruited in our study. Stress hyperglycemia was evaluated by the index of the glucose-to-HbA1c ratio that was calculated by fasting blood glucose (mmol/L) divided by HbA1c (%). Patients were divided into two groups based on the median of the glucose-to-HbA1c ratio. The main outcomes were poor functional outcomes (modified Rankin Scale score of 3–6) at discharge and 90 days. Multivariable logistic regression and stratified analyses were performed to explore the association of stress hyperglycemia with poor prognosis of ICH.
Conclusion
Stress hyperglycemia, calculated by glucose-to-HbA1c ratio, was independently correlated with worse functional outcomes at discharge and 90 days in patients with ICH. Moreover, glucose-to-HbA1c ratio, might not only be used as a simple and readily available index to predict clinical outcomes of ICH but also provide meaningful insight into future analysis to investigate the optimal range of glucose levels among ICH patients and develop tailored glucose-lowering strategies.
Main results
On multivariable analysis, higher glucose-to-HbA1c ratio (≥1.02) was independently correlated with poor functional outcomes at discharge (adjusted OR=3.52, 95%CI: 1.98-6.23) and 90 days (adjusted OR=2.27, 95%CI: 1.38-3.73) after adjusting for potential confounding factors. The correlation between glucose-to-HbA1c ratio and worse functional outcomes still retained in patients with or without diabetes mellitus.