Glycemic Gap Predicts in-Hospital Mortality in Diabetic Patients with Intracerebral Hemorrhage.
Glycemic Gap Predicts in-Hospital Mortality in Diabetic Patients with Intracerebral Hemorrhage.
复制标题
血糖差距可预测糖尿病脑出血患者的院内死亡率。
DOI：
10.1016/j.jstrokecerebrovasdis.2021.105669
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Divani,AfshinA
中科院分区：
文献类型：
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作者：
Zarean,Elaheh;Lattanzi,Simona;Looha,MehdiAzizmohammad;Napoli,MarioDi;Chou,SherryH-Y;Jafarli,Alibay;Torbey,Michel;Divani,AfshinA
背景和目的入院时高血糖与脑出血（ICH）预后的关系仍存在争议。与入院血糖水平相比，血糖间隙（GG）是葡萄糖对身体应激的稳态反应的上级指标。我们的目的是评估GG和住院死亡率之间的关联在ICH.MethodsWe回顾性地确定了连续的自发性ICH住院患者在2个医疗保健系统在双子城地区，MN，2008年1月至2017年12月。排除了未进行糖化血红蛋白（HbA 1c）检测或ICH后24小时后入院的患者。记录人口统计学、病史、入院检查和计算机断层扫描数据。使用入院血糖水平减去HbA 1c衍生的平均血糖计算GG。通过考克斯回归分析评估GG与至住院死亡时间之间的相关性。接受者工作特征（ROC）分析与德隆测试被用来评估GG预测在医院death.ResultsAmong 345例纳入研究对象，63（25.7%）在住院期间死亡的能力。与存活者相比，死亡者入院时格拉斯哥昏迷评分较低，血肿体积较大，白色血细胞计数、血糖和GG水平较高（p<0.001）。在校正已知ICH结局预测因素和潜在混杂因素后，GG仍然是院内死亡率的独立预测因素[校正后风险比：1.09，95%置信区间（CI）：1.02-1.18，p = 0.018]。GG表现出良好的判别力（ROC曲线下面积：0.75，95%CI：0.68-0.82）在预测住院死亡和糖尿病患者（P = 0.030的DeLong测试）比入院血糖水平更好。
Background and PurposeThe 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.MethodsWe 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.ResultsAmong 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).ConclusionsAdmission GG is associated with the risk of in-hospital mortality and can potentially represent a useful prognostic biomarker for ICH patients with diabetes.