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Glycemic Gap Predicts In-Hospital Mortality in Diabetic Patients With Intracerebral Hemorrhage Publisher Pubmed



Zarean E1, 2 ; Lattanzi S3 ; Looha MA4 ; Napoli MD5 ; Chou SHY6 ; Jafarli A1 ; Torbey M1 ; Divani AA1
Authors
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Authors Affiliations
  1. 1. Department of Neurology, University of New Mexico, NM, United States
  2. 2. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
  4. 4. Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  5. 5. Neurological Service, SS Annunziata Hospital, Sulmona, L'Aquila, Italy
  6. 6. Departments of Critical Care Medicine, Neurology, & Neurosurgery, University of Pittsburgh, PA, United States

Source: Journal of Stroke and Cerebrovascular Diseases Published:2021


Abstract

Background and Purpose: The relationship between admission hyperglycemia and intracerebral hemorrhage (ICH) outcome remains controversial. Glycemic gap (GG) is a superior indicator of glucose homeostatic response to physical stress compared to admission glucose levels. We aimed to evaluate the association between GG and in-hospital mortality in ICH. Methods: We retrospectively identified consecutive patients hospitalized for spontaneous ICH at the 2 healthcare systems in the Twin Cities area, MN, between January 2008 and December 2017. Patients without glycosylated hemoglobin (HbA1c) test or those admitted beyond 24 hours post-ICH were excluded. Demographics, medical history, admission tests, and computed tomography data were recorded. GG was computed using admission glucose level minus HbA1c-derived average glucose. The association between GG and time to in-hospital mortality was evaluated by Cox regression analysis. Receiver operating characteristic (ROC) analysis with the DeLong test was used to evaluate the ability of GG to predict in-hospital death. Results: Among 345 included subjects, 63 (25.7%) died during the hospital stay. Compared with survivors, non-survivors presented with a lower Glasgow coma scale score, larger hematoma volume, and higher white blood cells count, glucose, and GG levels at admission (p<0.001). GG remained an independent predictor of in-hospital mortality after adjusting for known ICH outcome predictors and potential confounders [adjusted hazard ratio: 1.09, 95% confidence interval (CI): 1.02-1.18, p = 0.018]. GG showed a good discriminative power (area under the ROC curve: 0.75, 95% CI: 0.68-0.82) in predicting in-hospital death and performed better than admission glucose levels in diabetic patients (p = 0.030 for DeLong test). Conclusions: Admission GG is associated with the risk of in-hospital mortality and can potentially represent a useful prognostic biomarker for ICH patients with diabetes. © 2021 Elsevier Inc.
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