Admission glycemic gap in the assessment of patients with intracerebral hemorrhage
Intracerebral hemorrhage (ICH) is the most common type of hemorrhagic stroke. Glycemic gap, determined by the difference between glucose and the HbA1c-derived average glucose, predicts poor outcomes in various clinical settings. Our main objective was to evaluate association of some admission factor...
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| Veröffentlicht in: | Clinical neurology and neurosurgery 2021-09, Vol.208, p.106871-106871, Article 106871 |
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| description | Intracerebral hemorrhage (ICH) is the most common type of hemorrhagic stroke. Glycemic gap, determined by the difference between glucose and the HbA1c-derived average glucose, predicts poor outcomes in various clinical settings. Our main objective was to evaluate association of some admission factors and outcomes in relation to admission glycemic gap (AGG) in patients with ICH.
We retrospectively analyzed 506 adult patients with ICH between 2014 and 2019. AGG was defined as A1c-derived average glucose (28.7×HbA1c-46.7) subtracted from admission glucose. Admission factors and hospital outcomes indicative of poor outcome (i.e. death, gastrostomy tube, tracheostomy, and discharge status) were compared between patients with elevated (greater than 80 mg/dL) vs. non-elevated (less than or equal-to 80 mg/dL) AGG. Pearson chi-square test was used for independence, and multivariate analysis was used for association. SPSS and excel were used for all data analysis.
We found that 67 of 506 (13%) ICH patients had elevated AGG with a mean of 137.3 mg/dL compared to 439 (87%) non-elevated AGG with a mean of 12.6 mg/dL. While mean and standard deviation values for age, weight,and body mass index were comparable between groups, the elevated AGG group had significantly higher admission glucose (286.1 ± 84.3 vs. 140.1 ± 42.5, p |
| doi_str_mv | 10.1016/j.clineuro.2021.106871 |
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We retrospectively analyzed 506 adult patients with ICH between 2014 and 2019. AGG was defined as A1c-derived average glucose (28.7×HbA1c-46.7) subtracted from admission glucose. Admission factors and hospital outcomes indicative of poor outcome (i.e. death, gastrostomy tube, tracheostomy, and discharge status) were compared between patients with elevated (greater than 80 mg/dL) vs. non-elevated (less than or equal-to 80 mg/dL) AGG. Pearson chi-square test was used for independence, and multivariate analysis was used for association. SPSS and excel were used for all data analysis.
We found that 67 of 506 (13%) ICH patients had elevated AGG with a mean of 137.3 mg/dL compared to 439 (87%) non-elevated AGG with a mean of 12.6 mg/dL. While mean and standard deviation values for age, weight,and body mass index were comparable between groups, the elevated AGG group had significantly higher admission glucose (286.1 ± 84.3 vs. 140.1 ± 42.5, p < 0.001), higher lactic acid (3.26 ± 2.04 mmol/L vs. 1.99 ± 1.33 mmol/L, p < 0.001), lower Glasgow Coma Scale (GCS) scores (7.70 ± 4.28 vs. 11.24 ± 4.14, p < 0.001), and higher ICH score (median 3, IQR 2–4 vs. median 1, IQR 0–3, p < 0.001). Higher AGG was associated with an increased likelihood of mechanical ventilation, and in-hospital mortality (74.6% vs. 38.3% and 47.8% vs. 15.0% respectively, p < 0.001). Placements of tracheostomy and gastrostomy were similar between the two groups (13.4% vs. 11.8%, p = 0.69% and 1.5% and 4.6%, p = 0.34 respectively). The higher AGG group had a more common poor discharge outcome to either long-term acute care, skilled nursing facility, and/or hospice (65.7% vs. 42.6%, p < 0.001). Hospital cost and length of hospitalization did not differ significantly. Although AGG was not an independent predictor of poor outcome, multivariate analysis showed it was significantly associated with poor outcome while admission glucose was not (p < 0.001 vs. p = 0.167).
Elevated AGG was associated with worse GCS and ICH scores on admission, as well as need for mechanical ventilation, in hospital mortality and poor discharge status. Elevated AGG has value in prediction of outcome, but existing understanding is limited.
•Admission Glycemic Gap (AGG) is a recently-proposed method to more-objectively evaluate stress-induced hyperglycemia in severe pathology.•ICH patients with elevated AGG showed significantly lower GCS, higher ICH Score, and poorer overall outcomes.•Multivariate analysis found that AGG was more closely associated with poor outcome than was currently-used admission glucose value.]]></description><identifier>ISSN: 0303-8467</identifier><identifier>EISSN: 1872-6968</identifier><identifier>DOI: 10.1016/j.clineuro.2021.106871</identifier><identifier>PMID: 34391085</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Acids ; Aged ; Blood Glucose - analysis ; Body mass index ; Cerebral Hemorrhage - blood ; Cerebral Hemorrhage - diagnosis ; Cerebral Hemorrhage - mortality ; Chi-square test ; Creatinine ; Diabetes ; Female ; Glucose ; Glycated Hemoglobin A - analysis ; Glycemic Gap ; Hemoglobin ; Hemorrhage ; Hospital Mortality ; Humans ; Hyperglycemia ; ICH ; Intracerebral hemorrhage ; Lactic acid ; Male ; Mechanical ventilation ; Metabolism ; Mortality ; Multivariate analysis ; Neurology ; Normal distribution ; Ostomy ; Outcome ; Pathophysiology ; Patient Admission ; Patient Discharge ; Patients ; Prognosis ; Retrospective Studies ; Stroke ; Tracheostomy ; Tracheotomy ; Ventilators</subject><ispartof>Clinical neurology and neurosurgery, 2021-09, Vol.208, p.106871-106871, Article 106871</ispartof><rights>2021</rights><rights>Copyright © 2021. Published by Elsevier B.V.</rights><rights>Copyright Elsevier Limited Sep 2021</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-ac3947f807dd11201cbada07f92f86391e0ab7d6f8c841f6c936c40f3ca7d0523</citedby><cites>FETCH-LOGICAL-c396t-ac3947f807dd11201cbada07f92f86391e0ab7d6f8c841f6c936c40f3ca7d0523</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0303846721004005$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34391085$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dorn, Amber Y.</creatorcontrib><creatorcontrib>Sun, Philip Y.</creatorcontrib><creatorcontrib>Sanossian, Nerses</creatorcontrib><creatorcontrib>Nguyen, Peggy L.</creatorcontrib><creatorcontrib>Emanuel, Benjamin A.</creatorcontrib><creatorcontrib>Kim-Tenser, May A.</creatorcontrib><creatorcontrib>Bulic, Sebina F.</creatorcontrib><title>Admission glycemic gap in the assessment of patients with intracerebral hemorrhage</title><title>Clinical neurology and neurosurgery</title><addtitle>Clin Neurol Neurosurg</addtitle><description><![CDATA[Intracerebral hemorrhage (ICH) is the most common type of hemorrhagic stroke. Glycemic gap, determined by the difference between glucose and the HbA1c-derived average glucose, predicts poor outcomes in various clinical settings. Our main objective was to evaluate association of some admission factors and outcomes in relation to admission glycemic gap (AGG) in patients with ICH.
We retrospectively analyzed 506 adult patients with ICH between 2014 and 2019. AGG was defined as A1c-derived average glucose (28.7×HbA1c-46.7) subtracted from admission glucose. Admission factors and hospital outcomes indicative of poor outcome (i.e. death, gastrostomy tube, tracheostomy, and discharge status) were compared between patients with elevated (greater than 80 mg/dL) vs. non-elevated (less than or equal-to 80 mg/dL) AGG. Pearson chi-square test was used for independence, and multivariate analysis was used for association. SPSS and excel were used for all data analysis.
We found that 67 of 506 (13%) ICH patients had elevated AGG with a mean of 137.3 mg/dL compared to 439 (87%) non-elevated AGG with a mean of 12.6 mg/dL. While mean and standard deviation values for age, weight,and body mass index were comparable between groups, the elevated AGG group had significantly higher admission glucose (286.1 ± 84.3 vs. 140.1 ± 42.5, p < 0.001), higher lactic acid (3.26 ± 2.04 mmol/L vs. 1.99 ± 1.33 mmol/L, p < 0.001), lower Glasgow Coma Scale (GCS) scores (7.70 ± 4.28 vs. 11.24 ± 4.14, p < 0.001), and higher ICH score (median 3, IQR 2–4 vs. median 1, IQR 0–3, p < 0.001). Higher AGG was associated with an increased likelihood of mechanical ventilation, and in-hospital mortality (74.6% vs. 38.3% and 47.8% vs. 15.0% respectively, p < 0.001). Placements of tracheostomy and gastrostomy were similar between the two groups (13.4% vs. 11.8%, p = 0.69% and 1.5% and 4.6%, p = 0.34 respectively). The higher AGG group had a more common poor discharge outcome to either long-term acute care, skilled nursing facility, and/or hospice (65.7% vs. 42.6%, p < 0.001). Hospital cost and length of hospitalization did not differ significantly. Although AGG was not an independent predictor of poor outcome, multivariate analysis showed it was significantly associated with poor outcome while admission glucose was not (p < 0.001 vs. p = 0.167).
Elevated AGG was associated with worse GCS and ICH scores on admission, as well as need for mechanical ventilation, in hospital mortality and poor discharge status. Elevated AGG has value in prediction of outcome, but existing understanding is limited.
•Admission Glycemic Gap (AGG) is a recently-proposed method to more-objectively evaluate stress-induced hyperglycemia in severe pathology.•ICH patients with elevated AGG showed significantly lower GCS, higher ICH Score, and poorer overall outcomes.•Multivariate analysis found that AGG was more closely associated with poor outcome than was currently-used admission glucose value.]]></description><subject>Acids</subject><subject>Aged</subject><subject>Blood Glucose - analysis</subject><subject>Body mass index</subject><subject>Cerebral Hemorrhage - blood</subject><subject>Cerebral Hemorrhage - diagnosis</subject><subject>Cerebral Hemorrhage - mortality</subject><subject>Chi-square test</subject><subject>Creatinine</subject><subject>Diabetes</subject><subject>Female</subject><subject>Glucose</subject><subject>Glycated Hemoglobin A - analysis</subject><subject>Glycemic Gap</subject><subject>Hemoglobin</subject><subject>Hemorrhage</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Hyperglycemia</subject><subject>ICH</subject><subject>Intracerebral hemorrhage</subject><subject>Lactic acid</subject><subject>Male</subject><subject>Mechanical ventilation</subject><subject>Metabolism</subject><subject>Mortality</subject><subject>Multivariate analysis</subject><subject>Neurology</subject><subject>Normal distribution</subject><subject>Ostomy</subject><subject>Outcome</subject><subject>Pathophysiology</subject><subject>Patient Admission</subject><subject>Patient Discharge</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Stroke</subject><subject>Tracheostomy</subject><subject>Tracheotomy</subject><subject>Ventilators</subject><issn>0303-8467</issn><issn>1872-6968</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkMFqGzEQhkVpaBy3rxAEufSy7mi1lrS3mpC2AUMhJGchSyNbZnflSrsNfvsqOM6hl5xGDN_M_PoIuWawYMDEt_3CdmHAKcVFDTUrTaEk-0BmTMm6Eq1QH8kMOPBKNUJekquc9wDAuVCfyCVveMtALWfkYeX6kHOIA912R4t9sHRrDjQMdNwhNTljzj0OI42eHswYyjPT5zDuCjImYzHhJpmO7rCPKe3MFj-TC2-6jF9e65w8_bh7vP1VrX__vL9drSvLWzFWppRGegXSOcZqYHZjnAHp29orUfIhmI10wiurGuaFbbmwDXhujXSwrPmcfD3tPaT4Z8I86vITi11nBoxT1vVSsKaFBlRBb_5D93FKQ0lXKAkNlyVGocSJsinmnNDrQwq9SUfNQL9Y13t9tq5frOuT9TJ4_bp-2vTo3sbOmgvw_QRg8fE3YNLZFpMWXUhoR-1ieO_GP6g2ltQ</recordid><startdate>202109</startdate><enddate>202109</enddate><creator>Dorn, Amber Y.</creator><creator>Sun, Philip Y.</creator><creator>Sanossian, Nerses</creator><creator>Nguyen, Peggy L.</creator><creator>Emanuel, Benjamin A.</creator><creator>Kim-Tenser, May A.</creator><creator>Bulic, Sebina F.</creator><general>Elsevier B.V</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202109</creationdate><title>Admission glycemic gap in the assessment of patients with intracerebral hemorrhage</title><author>Dorn, Amber Y. ; Sun, Philip Y. ; Sanossian, Nerses ; Nguyen, Peggy L. ; Emanuel, Benjamin A. ; Kim-Tenser, May A. ; Bulic, Sebina F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-ac3947f807dd11201cbada07f92f86391e0ab7d6f8c841f6c936c40f3ca7d0523</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Acids</topic><topic>Aged</topic><topic>Blood Glucose - analysis</topic><topic>Body mass index</topic><topic>Cerebral Hemorrhage - blood</topic><topic>Cerebral Hemorrhage - diagnosis</topic><topic>Cerebral Hemorrhage - mortality</topic><topic>Chi-square test</topic><topic>Creatinine</topic><topic>Diabetes</topic><topic>Female</topic><topic>Glucose</topic><topic>Glycated Hemoglobin A - analysis</topic><topic>Glycemic Gap</topic><topic>Hemoglobin</topic><topic>Hemorrhage</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Hyperglycemia</topic><topic>ICH</topic><topic>Intracerebral hemorrhage</topic><topic>Lactic acid</topic><topic>Male</topic><topic>Mechanical ventilation</topic><topic>Metabolism</topic><topic>Mortality</topic><topic>Multivariate analysis</topic><topic>Neurology</topic><topic>Normal distribution</topic><topic>Ostomy</topic><topic>Outcome</topic><topic>Pathophysiology</topic><topic>Patient Admission</topic><topic>Patient Discharge</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Stroke</topic><topic>Tracheostomy</topic><topic>Tracheotomy</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dorn, Amber Y.</creatorcontrib><creatorcontrib>Sun, Philip Y.</creatorcontrib><creatorcontrib>Sanossian, Nerses</creatorcontrib><creatorcontrib>Nguyen, Peggy L.</creatorcontrib><creatorcontrib>Emanuel, Benjamin A.</creatorcontrib><creatorcontrib>Kim-Tenser, May A.</creatorcontrib><creatorcontrib>Bulic, Sebina F.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical neurology and neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dorn, Amber Y.</au><au>Sun, Philip Y.</au><au>Sanossian, Nerses</au><au>Nguyen, Peggy L.</au><au>Emanuel, Benjamin A.</au><au>Kim-Tenser, May A.</au><au>Bulic, Sebina F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Admission glycemic gap in the assessment of patients with intracerebral hemorrhage</atitle><jtitle>Clinical neurology and neurosurgery</jtitle><addtitle>Clin Neurol Neurosurg</addtitle><date>2021-09</date><risdate>2021</risdate><volume>208</volume><spage>106871</spage><epage>106871</epage><pages>106871-106871</pages><artnum>106871</artnum><issn>0303-8467</issn><eissn>1872-6968</eissn><abstract><![CDATA[Intracerebral hemorrhage (ICH) is the most common type of hemorrhagic stroke. Glycemic gap, determined by the difference between glucose and the HbA1c-derived average glucose, predicts poor outcomes in various clinical settings. Our main objective was to evaluate association of some admission factors and outcomes in relation to admission glycemic gap (AGG) in patients with ICH.
We retrospectively analyzed 506 adult patients with ICH between 2014 and 2019. AGG was defined as A1c-derived average glucose (28.7×HbA1c-46.7) subtracted from admission glucose. Admission factors and hospital outcomes indicative of poor outcome (i.e. death, gastrostomy tube, tracheostomy, and discharge status) were compared between patients with elevated (greater than 80 mg/dL) vs. non-elevated (less than or equal-to 80 mg/dL) AGG. Pearson chi-square test was used for independence, and multivariate analysis was used for association. SPSS and excel were used for all data analysis.
We found that 67 of 506 (13%) ICH patients had elevated AGG with a mean of 137.3 mg/dL compared to 439 (87%) non-elevated AGG with a mean of 12.6 mg/dL. While mean and standard deviation values for age, weight,and body mass index were comparable between groups, the elevated AGG group had significantly higher admission glucose (286.1 ± 84.3 vs. 140.1 ± 42.5, p < 0.001), higher lactic acid (3.26 ± 2.04 mmol/L vs. 1.99 ± 1.33 mmol/L, p < 0.001), lower Glasgow Coma Scale (GCS) scores (7.70 ± 4.28 vs. 11.24 ± 4.14, p < 0.001), and higher ICH score (median 3, IQR 2–4 vs. median 1, IQR 0–3, p < 0.001). Higher AGG was associated with an increased likelihood of mechanical ventilation, and in-hospital mortality (74.6% vs. 38.3% and 47.8% vs. 15.0% respectively, p < 0.001). Placements of tracheostomy and gastrostomy were similar between the two groups (13.4% vs. 11.8%, p = 0.69% and 1.5% and 4.6%, p = 0.34 respectively). The higher AGG group had a more common poor discharge outcome to either long-term acute care, skilled nursing facility, and/or hospice (65.7% vs. 42.6%, p < 0.001). Hospital cost and length of hospitalization did not differ significantly. Although AGG was not an independent predictor of poor outcome, multivariate analysis showed it was significantly associated with poor outcome while admission glucose was not (p < 0.001 vs. p = 0.167).
Elevated AGG was associated with worse GCS and ICH scores on admission, as well as need for mechanical ventilation, in hospital mortality and poor discharge status. Elevated AGG has value in prediction of outcome, but existing understanding is limited.
•Admission Glycemic Gap (AGG) is a recently-proposed method to more-objectively evaluate stress-induced hyperglycemia in severe pathology.•ICH patients with elevated AGG showed significantly lower GCS, higher ICH Score, and poorer overall outcomes.•Multivariate analysis found that AGG was more closely associated with poor outcome than was currently-used admission glucose value.]]></abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>34391085</pmid><doi>10.1016/j.clineuro.2021.106871</doi><tpages>1</tpages></addata></record> |
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| subjects | Acids Aged Blood Glucose - analysis Body mass index Cerebral Hemorrhage - blood Cerebral Hemorrhage - diagnosis Cerebral Hemorrhage - mortality Chi-square test Creatinine Diabetes Female Glucose Glycated Hemoglobin A - analysis Glycemic Gap Hemoglobin Hemorrhage Hospital Mortality Humans Hyperglycemia ICH Intracerebral hemorrhage Lactic acid Male Mechanical ventilation Metabolism Mortality Multivariate analysis Neurology Normal distribution Ostomy Outcome Pathophysiology Patient Admission Patient Discharge Patients Prognosis Retrospective Studies Stroke Tracheostomy Tracheotomy Ventilators |
| title | Admission glycemic gap in the assessment of patients with intracerebral hemorrhage |
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