Glycemic Gap Predicts in-Hospital Mortality in Diabetic Patients with Intracerebral Hemorrhage

Zarean, Elaheh; Lattanzi, Simona; Looha, Mehdi Azizmohammad; Napoli, Mario Di; Chou, Sherry; Jafarli, Alibay; Torbey, Michel T.; Divani, Afshin A.

doi:10.1016/j.jstrokecerebrovasdis.2021.105669

Cited by 19 publications

(18 citation statements)

References 25 publications

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“…A recent study demonstrated admission GG was associated with the risk of in-hospital mortality in ICH patients with diabetes, which is in accord with our results. 28 However, we performed a more comprehensive study, including more prognostic markers apart from mortality and hematoma expansion. Besides, distinct from the markers with the aforementioned second defect, SHR can be altered by regulating the blood glucose.…”

Section: Discussionmentioning

confidence: 99%

The stress hyperglycemia ratio predicts early hematoma expansion and poor outcomes in patients with spontaneous intracerebral hemorrhage

Chu

Huang

Tang

et al. 2022

Ther Adv Neurol Disord

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Background: Different from diabetic hyperglycemia, stress-induced hyperglycemia (SIH) can better reflect elevated blood glucose owing to intracerebral hemorrhage (ICH). However, studies about the outcome of ICH patients with SIH are still very limited. Aims: This study aimed to investigate whether SIH measured by stress-induced hyperglycemia ratio (SHR) was associated with hematoma expansion and poor outcomes in patients with ICH. Methods: A consecutive series of patients with spontaneous ICH from two clinical centers admitted within 24 h after symptom onset were enrolled for prospective analysis. SHR was defined as admission fasting blood glucose divided by estimated average glucose [1.59 × Hemoglobin A1c (%) − 2.59]. This study investigated the association between SHR and hematoma expansion, and short-term and long-term poor outcomes using univariate and multivariate logistic regression analyses. Results: A total of 313 ICH patients were enrolled in the study. SHR was markedly higher in patients with hematoma expansion and poor outcomes ( p < 0.001). The multivariate logistic regression analysis demonstrated SHR independently associated with hematoma expansion ( p < 0.001) and poor outcomes, including secondary neurological deterioration within 48 h, 30-day mortality, and 3-month poor modified Rankin Scale (mRS 4–6) ( p < 0.001), while the blood glucose only predicted 30-day mortality. Meanwhile, the diagnostic accuracy of SHR exhibited by area under the curve in receiver operating characteristic analysis was statistically equal to or higher than the well-known predictors. Conclusion: SHR is a reliable predictor for early hematoma expansion and poor outcomes in patients with ICH.

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Section: Discussionmentioning

confidence: 99%

The stress hyperglycemia ratio predicts early hematoma expansion and poor outcomes in patients with spontaneous intracerebral hemorrhage

Chu

Huang

Tang

et al. 2022

Ther Adv Neurol Disord

View full text Add to dashboard Cite

show abstract

“…However, hyperglycemia should be considered along with the pre-existing glycemic control status to reflect acute physiological stress. For this purpose, previous studies have utilized the glycemic gap as a surrogate marker for stress-induced hyperglycemia (SIH) by subtracting the HbA1c-derived estimated average glucose (eAG) from the initial serum glucose [ 5 , 6 , 7 , 8 ]. A recent study revealed that an elevated glycemic gap upon admission is a significant predictor for poor functional outcomes three months after a stroke [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of Glycemic Gap on Post-Stroke Cognitive Impairment in Acute Ischemic Stroke Patients

et al. 2021

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Background: Post-stroke hyperglycemia is a frequent finding in acute ischemic stroke patients and is associated with poor functional and cognitive outcomes. However, it is unclear as to whether the glycemic gap between the admission glucose and HbA1c-derived estimated average glucose (eAG) is associated with post-stroke cognitive impairment (PSCI). Methods: We enrolled acute ischemic stroke patients whose cognitive functions were evaluated three months after a stroke using the Korean version of the vascular cognitive impairment harmonization standards neuropsychological protocol (K-VCIHS-NP). The development of PSCI was defined as having z-scores of less than −2 standard deviations in at least one cognitive domain. The participants were categorized into three groups according to the glycemic gap status: non-elevated (initial glucose − eAG ≤ 0 mg/dL), mildly elevated (0 mg/dL < initial glucose − eAG < 50 mg/dL), and severely elevated (50 mg/dL ≤ initial glucose − eAG). Results: A total of 301 patients were enrolled. The mean age was 63.1 years, and the median National Institute of Health Stroke Scale (NIHSS) score was two (IQR: 1–4). In total, 65 patients (21.6%) developed PSCI. In multiple logistic regression analyses, the severely elevated glycemic gap was a significant predictor for PSCI after adjusting for age, sex, education level, initial stroke severity, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and left hemispheric lesion (aOR: 3.65, p-value = 0.001). Patients in the severely elevated glycemic gap group showed significantly worse performance in the frontal and memory domains. Conclusions: In conclusion, our study demonstrated that an elevated glycemic gap was significantly associated with PSCI three months after a stroke, with preferential involvement of frontal and memory domain dysfunctions.

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“…Previous studies showed that stress hyperglycemia is associated with poor outcomes in patients with severe illnesses such as acute myocardiac infarction, trauma, and acute ischemic stroke. 6 , 8 , 9 Zarean et al 23 showed that the glycemic gap was associated with mortality in patients with diabetes and hemorrhagic stroke. Nevertheless, the association between stress hyperglycemia and acute ischemic stroke in patients with diabetes was rarely reported.…”

Section: Discussionmentioning

confidence: 99%

Stress hyperglycemia is associated with in‐hospital mortality in patients with diabetes and acute ischemic stroke

et al. 2022

CNS Neurosci Ther

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Glycemic Gap Predicts in-Hospital Mortality in Diabetic Patients with Intracerebral Hemorrhage

Cited by 19 publications

References 25 publications

The stress hyperglycemia ratio predicts early hematoma expansion and poor outcomes in patients with spontaneous intracerebral hemorrhage

The stress hyperglycemia ratio predicts early hematoma expansion and poor outcomes in patients with spontaneous intracerebral hemorrhage

Effects of Glycemic Gap on Post-Stroke Cognitive Impairment in Acute Ischemic Stroke Patients

Stress hyperglycemia is associated with in‐hospital mortality in patients with diabetes and acute ischemic stroke

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