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

作者：Yanchun Wu, Zan Ding, Jiang Wu, Yuan Yuan Wang, Sheng-Chao Zhang, Ye Wen, Wenya Dong, Qingying Zhang · 发表于：Journal of neurosurgery · 年份：2017 · DOI：10.3171/2017.4.jns162238 · 被引用次数：20 · 研究领域：Intracerebral and Subarachnoid Hemorrhage Research、Hyperglycemia and glycemic control in critically ill and hospitalized patients、Neurological and metabolic disorders

OBJECTIVE Intracerebral hemorrhage (ICH) is associated with a poor prognosis and high mortality, but no study has elucidated the association between glycemic variability (GV) and functional outcome in ICH. The authors of this study aimed to determine whether GV is a predictor of 30-day functional outcome in ICH patients. METHODS The study recruited 366 patients with first-ever acute-onset ICH in the period during 2014 and 2015. Fasting blood glucose was assessed on admission and with 7-day continuous monitoring. Glycemic variability was calculated and expressed by the standard deviation (Glu SD ) and coefficient of variation (Glu CV ). Patients were divided into groups of those with diabetes mellitus (DM), stress hyperglycemia (SHG), and normal glucose (NG). Functional outcome was measured using the modified Rankin Scale. RESULTS The numbers of patients with DM, SHG, and NG were 108 (29.5%), 127 (34.7%), and 131 (35.8%), respectively. As compared with the DM patients, those with SHG had higher mortality (29.9% vs 15.7%, p < 0.05) and a poorer prognosis (64.6% vs 52.8%, p < 0.05). Poor prognosis was associated with both high Glu SD (OR 1.54, 95% CI 1.19–1.99) and high Glu CV (1.05, 1.02–1.09), especially in the DM group. The area under the receiver operating characteristic curve was greater for the Glu SD (OR 0.929, 95% CI 0.902–0.956) and the Glu CV (0.932, 0.906–0.958) model than the original model (0.860, 0.823–0.898) in predicting a poor outcome. CONCLUSIONS Stress h...