Prognostic value of glycemic gap in patients with spontaneous intracerebral hemorrhage

Abstract

Background and purpose Glycemic gap (GG), as a novel biomarker showing the acute glycemic change after the onset of acute illness, has been found to be associated with adverse outcomes in many diseases. This study aimed to explore the prognostic value of GG on long‐term outcomes of spontaneous intracerebral hemorrhage (sICH). Methods The current study included 528 patients from a multicenter, prospective, consecutive, observational cohort study. Poor clinical outcome was defined as modified Rankin Scale ≥ 3. GG was calculated using admission blood glucose minus hemoglobin A1c‐derived average blood glucose. Logistic regression analyses were performed to determine the association between GG and poor clinical outcomes at 30 days, 90 days, and 1 year. Results Glycemic gap was significantly associated with poor clinical outcomes at 30 days, 90 days, and 1 year (p < 0.05 for all models), where patients with higher GG were more likely to have poor clinical outcome. Restricted cubic splines revealed a positive association between GG and poor clinical outcome. In addition, patients with higher GG were more likely to have a higher 1‐year mortality rate. The addition of GG to the intracerebral hemorrhage score improved the discrimination and calibration properties for the prediction of poor clinical outcome. Conclusions Glycemic gap was independently associated with poor outcomes and may be a valuable prognostic factor in patients with sICH.

Diabetic and stress‐induced hyperglycemia in spontaneous intracerebral hemorrhage: A multicenter prospective cohort (CHEERY) study

“…HbA1c is a reliable measure of the mean glucose concentration over the last 3‐ to 4‐months, 19,20 which could recognize occult diabetes. Chu et al analyzed HbA1c values and found that SIH was related to the risk of death and adverse prognosis after ICH 13,46,47 . In this study, we combined the levels of HbA1c and admission glucose, along with DM history to distinguish between SIH and DM and classified patients into four groups: NDN, DN, DH, and SIH, as mentioned previously.…”

“…Chu et al analyzed HbA1c values and found that SIH was related to the risk of death and adverse prognosis after ICH. 13,46,47 In this study, we combined the levels of HbA1c and admission glucose, along with DM history to distinguish between SIH and DM and classified patients into four groups: NDN, DN, DH, and SIH, as mentioned previously. We found that around 1/5 of patients (20.5%) had a history of DM, consistent with a previous report in which 15%-30% of patients with ICH had DM.…”

Comparison of stress hyperglycemia ratio and glycemic gap on acute ICH in‐hospital outcomes

“…In addition, insulin resistance could also elevate the serum glucose level 30 . All of the above could exert deleterious effects on the blood–brain barrier and parenchymal cells and then exacerbate the brain injury 23 . Besides, stress‐induced hyperglycemia could interfere with the process of ATP generation by causing calcium influx into mitochondria and downregulate aquaporin‐4 in the brain, leading to brain edema, neuronal apoptosis, and the destruction of the brain–blood barrier 31,32 .…”

Association of glycemic gap with stroke recurrence in patients with ischemic stroke

“…The glycemic gap is a surrogate marker calculated by subtracting the HbA1c‐derived estimated average glucose from blood glucose and may reflect glycemic excursion in the acute phase 13 . Prior reports revealed that the glycemic gap was associated with left ventricular systolic dysfunction in patients with myocardial infarction 14 and contributed to poor outcomes in patients with spontaneous intracerebral hemorrhage 15 . Nevertheless, studies evaluating the relationship between the glycemic gap and stroke recurrence regarding DM and AF remain limited at present.…”

“… 13 Prior reports revealed that the glycemic gap was associated with left ventricular systolic dysfunction in patients with myocardial infarction 14 and contributed to poor outcomes in patients with spontaneous intracerebral hemorrhage. 15 Nevertheless, studies evaluating the relationship between the glycemic gap and stroke recurrence regarding DM and AF remain limited at present. Hence, this study aimed to explore the correlation between glycemic gap and long‐term stroke recurrence in patients with ischemic stroke.…”