Increased glycemic variability associated with a poor 30-day functional outcome in acute intracerebral hemorrhage

Wu, Yanchun; Ding, Zan; Wu, Jiang; Wang, Yuan‐Yuan; Zhang, Sheng-Chao; Wen, Yan; Dong, Wenchen; Zhang, Qingying

doi:10.3171/2017.4.jns162238

Cited by 9 publications

(18 citation statements)

References 40 publications

(45 reference statements)

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“…81 Similarly, a poorer 30-day functional outcome following acute intracerebral hemorrhage was observed in those without diabetes and increased GV. 79 In those persons with an HbA1c > 8•5%, increasing GV was not associated with increased mortality. 82 Hypoglycaemia was also associated with mortality, but prior exposure to hyperglycaemia had a lesser effect on this relationship.…”

Section: Glucose Variability: Hard Outcomes In Persons With and Withomentioning

confidence: 91%

“…76 GV also seems to indicate an increased risk of a major cardiovascular event after 30 days following acute coronary syndrome, 77 isolated cardiac valvular surgery 78 and intracerebral haemorrhage. 79 More recently, GV has also been associated with higher risk of mortality in the general population. 80 Interestingly, increased GV has been found to be strongly associated with mortality in ICU in persons without diabetes, but less so in those with diabetes.…”

Section: Glucose Variability: Hard Outcomes In Persons With and Withomentioning

confidence: 99%

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Glycaemic variability in diabetes: clinical and therapeutic implications

Ceriello

Monnier

Owens

2019

The Lancet Diabetes & Endocrinology

375

342

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Glycaemic variability is an integral component of glucose homoeostasis. Although it has not yet been definitively confirmed as an independent risk factor for diabetes complications, glycaemic variability can represent the presence of excess glycaemic excursions and, consequently, the risk of hyperglycaemia or hypoglycaemia. Glycaemic variability is currently defined by a large and increasing number of metrics, representing either short-term (within-day and between-day variability) or long-term glycaemic variability, which is usually based on serial measurements of HbA or other measures of glycaemia over a longer period of time. In this Review, we discuss recent evidence examining the association between glycaemic variability and diabetes-related complications, as well as non-pharmacological and pharmacological strategies currently available to address this challenging aspect of diabetes management.

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Section: Glucose Variability: Hard Outcomes In Persons With and Withomentioning

confidence: 91%

Section: Glucose Variability: Hard Outcomes In Persons With and Withomentioning

confidence: 99%

Glycaemic variability in diabetes: clinical and therapeutic implications

Ceriello

Monnier

Owens

2019

The Lancet Diabetes & Endocrinology

375

342

View full text Add to dashboard Cite

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“…We recorded hematoma location (lobar, basal ganglia, thalamus, brainstem, cerebellum), hematoma volume and intraventricular extension according to first computerized tomography (CT) scans, which were completed within 24 hours after admission. Hematoma volume were measured using the ABC/2 method described in previous studies 14,15 , and were classified into large hematoma (≥30 ml) or small hematoma (<30 ml). For patients who arrived at the hospital within 6 hours of onset, CT was re-examined at 24 hours after onset to confirm whether there was a hematoma expansion.…”

Section: Methodsmentioning

confidence: 99%

Association of pre- and post-stroke glycemic status with clinical outcome in spontaneous intracerebral hemorrhage

Kang

et al. 2019

Sci Rep

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In this study, we aimed to disclose the association of pre- and post-stroke glycemic status with clinical outcome in patients with spontaneous intracerebral hemorrhage (sICH). It was a multicenter, prospective, observational cohort study, conducted in 13 hospitals in Beijing from January 2014 to September 2016. The association of admission random blood glucose (RBG), fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) with clinical outcome at 90 days after sICH onset were analyzed comprehensively. Poor outcome was defined as death or modified Rankin Scale (mRS) score >2. The results showed that elevated RBG and FBG were associated with larger hematoma volume, lower GCS, higher NIHSS (P < 0.001), and poor outcome, but HbA1c was not (P > 0.05). In stratified analysis, the association of poor outcome with elevated FBG or RBG retained statistical significance just in patients without diabetes. Kaplan-Meier curve and Cox regression showed that patients with elevated FBG or RBG had significantly higher risk of death within 90 days (P < 0.05). So we conclude that poststroke hyperglycemia was associated with larger hematoma volume, severe neurological damage and poor clinical outcome, but HbA1c was not relevant to hematoma volume or clinical outcome in patients with sICH.

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“…Even though glucose returns to normal after the illness or injury abates, hyperglycemia, including pre-admission glycemic control and admission hyperglycemia, appears to be independently associated with perioperative morbidity [26]. Emerging research has demonstrated that there may be additional factors, such as intraoperative glucose variability, that impact postoperative morbidity [27,28]. These findings underscore the need for additional research into specific treatment thresholds based on patient comorbidities and physiologic response to surgery [29].…”

Section: Discussionmentioning

confidence: 99%

Association of intraoperative hyperglycemia and postoperative outcomes in patients undergoing non-cardiac surgery: a multicenter retrospective study

et al. 2020

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Background: While pre and postoperative hyperglycemia is associated with increased risk of surgical site infection, myocardial infarction, stroke and risk of death, there are no multicenter data regarding the association of intraoperative blood glucose levels and outcomes for the non-cardiac surgical population. Methods: We conducted a retrospective cohort study from the Michigan Surgical Quality Collaborative, a network of 64 hospitals that prospectively collects validated data on surgical patients for the purpose of quality improvement. We included data for adult general, vascular, endocrine, hepatobiliary, and gastrointestinal operations between 2013 and 2015. We assessed the risk-adjusted, independent relationship between intraoperative hyperglycemia (glucose > 180) and the primary outcome of 30-day morbidity/mortality and secondary outcome of infectious complications using multivariable logistic regression modelling. Post hoc sensitivity analysis to assess the association between blood glucose values ≥250 mg/dL and outcomes was also performed. Results: Ninety-two thousand seven hundred fifty-one patients underwent surgery between 2013 and 2015 and 5014 (5.4%) had glucose testing intra-operatively. Of these patients, 1647 patients (32.9%) experienced the primary outcome, and 909 (18.1%) the secondary outcome. After controlling for patient comorbidities and surgical factors, peak intraoperative glucose > 180 mg/dL was not an independent predictor of 30-day mortality/morbidity (adjusted OR 1.05, 95%CI:0.86 to 1.28; p-value 0.623; model c-statistic of 0.720) or 30-day infectious complications (adjusted OR 0.93, 95%CI:0.74,1.16; p 0.502; model c-statistic of 0.709). Subgroup analysis for patients with or without diabetes yielded similar results. Sensitivity analysis demonstrated blood glucose of 250 mg/dL was a predictor of 30-day mortality/morbidity (adjusted OR: 1.59, 95% CI: 1.24, 2.05; p < 0.001). Conclusions: Among more than 5000 patients across 64 hospitals who had glucose measurements during surgery, there was no difference in postoperative outcomes between patients who had intraoperative glucose > 180 mg/ dL compared to patients with glucose values ≤180 mg/ dL.

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Increased glycemic variability associated with a poor 30-day functional outcome in acute intracerebral hemorrhage

Cited by 9 publications

References 40 publications

Glycaemic variability in diabetes: clinical and therapeutic implications

Glycaemic variability in diabetes: clinical and therapeutic implications

Association of pre- and post-stroke glycemic status with clinical outcome in spontaneous intracerebral hemorrhage

Association of intraoperative hyperglycemia and postoperative outcomes in patients undergoing non-cardiac surgery: a multicenter retrospective study

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