Quantitative Analysis of Stress-Induced Hyperglycemia and Intracranial Blood Volumes for Predicting Mortality After Intracerebral Hemorrhage

Nouh, Claire Delpirou; Ray, Bappaditya; Xu, Chao; Danala, Gopichandh; Koriesh, Ahmed; Hollabaugh, Kimberly; Gordon, David; Sidorov, Evgeny

doi:10.1007/s12975-022-00985-x

Cited by 10 publications

(16 citation statements)

References 27 publications

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“…Previous literature showed a significant association between GG and in‐hospital mortality of sICH in nondiabetic patients but not in diabetic patients [14]. Similarly, our subgroup analysis showed the OR value for poor clinical outcome was higher in nondiabetic patients.…”

Section: Discussionsupporting

confidence: 79%

“…The ICH Functional Outcome Score, including admission blood glucose, has been demonstrated to have a better discriminative ability than the ICH score alone [36,37]. A recent study showed the combination of the ICH score and GG had a higher Cstatistic value in predicting the in-hospital mortality than the ICH score alone [14]. In the present study, we found that the addition of GG to the ICH score significantly improved the predictive value for poor clinical outcome in all follow-ups, which highlights the importance of counting GG in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, GG was related to the severity and short-term outcomes of ischemic stroke [26]. It has been demonstrated that GG was a prognostic biomarker for in-hospital mortality in sICH patients [13,14]. However, the predictive value of GG for sICH patients during follow-up is still unknown.…”

Section: Discussionmentioning

confidence: 99%

“…GG has been identified to be significantly associated with adverse prognosis in patients with admission to an intensive care unit [10,11] and patients hospitalized for acute myocardial infarction [12]. Studies have shown that GG was an independent prognostic biomarker for in-hospital mortality in patients with sICH [13,14]. However, to our knowledge, the prognostic value of GG on long-term outcomes remains unknown.…”

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confidence: 99%

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Prognostic value of glycemic gap in patients with spontaneous intracerebral hemorrhage

Wang

et al. 2022

Euro J of Neurology

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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.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Prognostic value of glycemic gap in patients with spontaneous intracerebral hemorrhage

Wang

et al. 2022

Euro J of Neurology

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“…As the most prevalent subtype of hemorrhagic stroke, spontaneous intracerebral hemorrhage (sICH) accounts for ≈15% of all strokes and is related to high morbidity and mortality of about 40%. 1,2 Despite advances in understanding various prognostic and risk factors as well as neural tissue response to the hematoma, 3–5 the prognosis remains poor, the therapy is mainly supportive and surgical interventions are limited to selected patients with signs of excessive mass effect, herniation, or hydrocephalus. 6–9 The scientific community is incrementally building knowledge about ICH pathophysiology to select potential treatment targets.…”

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confidence: 99%

Mechanism of Spontaneous Intracerebral Hemorrhage Formation: An Anatomical Specimens-Based Study

Rzepliński

Sługocki

Tarka

et al. 2022

Stroke

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Background: Despite advances in understanding various risk and prognostic factors, spontaneous intracerebral hemorrhage is connected to very high morbidity and mortality, while the therapy is mainly supportive. Understanding of the pathophysiology of initial hematoma expansion is limited due to insufficient clinical data and lack of a suitable animal model. Methods: We injected 40 anatomic specimens of the basal ganglia with contrast medium, scanned them with a micro-computed tomography scanner and analyzed the results of radiological studies, direct and histological examinations. Results: In 9 cases, micro-computed tomography and histological examinations revealed contrast medium extravasations mimicking intracerebral hematomas. The artificial hematomas spread both proximally and distally along the ruptured perforator and its branches in the perivascular spaces and detached the branches from the adjacent neural tissue leading to destruction of the tissue and secondary extravasations. Moreover, some contrast extravasations skipped to the perivascular spaces of unruptured perforators, created further extravasation sites and aggravated the expansion of the artificial hematoma. There was no subarachnoid extension of any artificial hematoma. Conclusions: We postulate that a forming basal ganglia intracerebral hematoma spreads initially in the perivascular space, detaches the branches from the neural tissue and causes secondary bleeding. It can also skip to the perivascular space of a nearby perforator. The proposed mechanism of hematoma initiation and formation explains extent of damage to the neural tissue, variability of growth in time and space, creation of secondary bleeding sites, and limited usefulness of surgical interventions. The model is reproducible, the extent of the artificial hematoma can be easily controlled, the rupture sites of the perforating arteries can be determined, and preparation of the model does not require specialized, expensive equipment apart from the micro-computed tomography scanner.

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

Zhang,

et al. 2024

Ann Clin Transl Neurol

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ObjectiveTo compare the effect of different indicators on stress‐induced hyperglycemia for predicting in‐hospital outcomes of acute intracerebral hemorrhage.MethodsUsing data from the Chinese Stroke Center Alliance database, which is a national, multicenter, prospective, and consecutive program. Stress‐induced hyperglycemia was described as glycemic gap (GG, defined as fasting blood glucose [FBG] minus estimated average blood glucose) and stress hyperglycemia ratio (SHR, defined as FBG‐to‐estimated average blood glucose ratio [SHR 1] or FBG‐to‐HbA1c ratio [SHR 2]). The primary outcome was in‐hospital mortality, and the second outcome was hematoma expansion.ResultsA total of 71,333 patients with acute intracerebral hemorrhage were included. In multivariate analyses, the highest levels of GG (OR 1.68, 95% CI 1.12–2.51), SHR 1 (OR 1.73, 95% CI 1.15–2.60), and SHR 2 (OR 2.07, 95% CI 1.33–3.23) were associated with in‐hospital death (all the p trends <0.01). Only the highest level of SHR 2 (OR 1.24 [1.02–1.51], p trend >0.05) was related to hematoma expansion. No association between GG or SHR 1 and hematoma expansion was observed. The areas under the ROC curve of GG, SHR 1, and SHR 2 for in‐hospital mortality were 0.8808 (95% CI 0.8603–0.9014), 0.8796 (95% CI 0.8589–0.9002), and 0.8806 (95% CI 0.8600–0.9012). The areas under the ROC curve of SHR 2 for hematoma expansion were 0.7133 (95% CI 0.6964–0.7302).InterpretationSHR (FBG‐to‐HbA1c ratio) was associated with both in‐hospital death and hematoma expansion in intracerebral hemorrhage, and might serve as an accessory indicator for the in‐hospital prognosis of intracerebral hemorrhage.

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Quantitative Analysis of Stress-Induced Hyperglycemia and Intracranial Blood Volumes for Predicting Mortality After Intracerebral Hemorrhage

Cited by 10 publications

References 27 publications

Prognostic value of glycemic gap in patients with spontaneous intracerebral hemorrhage

Prognostic value of glycemic gap in patients with spontaneous intracerebral hemorrhage

Mechanism of Spontaneous Intracerebral Hemorrhage Formation: An Anatomical Specimens-Based Study

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

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