Mindong Hospital Afiliated to Fujian Medical University, Fuan, Fujian, 355000, People's Republic of China.
BMC Neurol. 2024 Sep 13;24(1):342. doi: 10.1186/s12883-024-03764-3.
Associations between HbA1c and adverse outcomes in ischemic and hemorrhagic stroke have been confirmed. It is still unclear whether HbA1c is related to the activities of daily living (ADL) score in complex chronic patients (CCP) with and without intracerebral hemorrhage (ICH).
The associations between HbA1c and ADL (Barthel score) in CCP with ICH and without ICH were evaluated, respectively.
We have analyzed data from a previous cohort study involving in 3594 CCPs without a ICH history at baseline, who were followed up for 5 years to assess ICH episode.
One hundred sixty-one ICH case were detected in a total of 3594 patients during the period of follow up for 5 years. Our nonlinear analysis suggested positive trends on the association between HBA1c and Barthel score in ICH and non-ICH patients, respectively. The multivariate linear regression analysis showed that elevated HbA1c was positively associated with a higher Barthel score among all study population (β = 1.25, 95% CI: 0.92, 1.59; P < 0.0001) with adjusted age and sex. Among non-ICH patients, increased HbA1c was still positively associated with an increased Barthel score (β = 1.24, 95% CI: 0.90, 1.58; P < 0.001). However, HbA1c appeared to have no any relationship with Barthel score in ICH patients (β = 1.87, 95% CI: -0.07, 3.82; P = 0.0613) after adjustment for age and sex. By additionally using sensitivity analysis, we still observed that the strong relationship was still existed in non-ICH patients (β = 0.90, 95% CI: 0.56, 1.24; P < 0.001) but not in ICH patients (β = 1.88, 95% CI: -0.10, 3.86; P = 0.0649).
We observed for the first time that elevated HbA1c is associated with better ADL in CCPs without ICH but not in those with ICH. This interesting discovery contradicts the traditional adverse effects of elevated HbA1c.
HbA1c 与缺血性和出血性卒中的不良结局之间的关联已得到证实。但在有和没有颅内出血（ICH）的复杂慢性病患者（CCP）中，HbA1c 是否与日常生活活动（ADL）评分相关尚不清楚。
分别评估有和没有 ICH 的 CCP 中 HbA1c 与 ADL（巴氏量表）之间的关系。
我们分析了一项先前队列研究的数据，该研究共纳入了 3594 例基线时无 ICH 病史的 CCP 患者，随访 5 年以评估 ICH 发作情况。
在 5 年的随访期间，总共在 3594 例患者中发现了 161 例 ICH 病例。我们的非线性分析表明，在 ICH 和非 ICH 患者中，HbA1c 与巴氏量表之间存在正相关趋势。多变量线性回归分析显示，在所有研究人群中，HbA1c 升高与巴氏量表评分较高呈正相关（β=1.25，95%CI：0.92，1.59；P<0.0001），且校正了年龄和性别。在非 ICH 患者中，HbA1c 升高仍然与巴氏量表评分增加呈正相关（β=1.24，95%CI：0.90，1.58；P<0.001）。然而，在校正年龄和性别后，HbA1c 与 ICH 患者的巴氏量表评分似乎没有任何关系（β=1.87，95%CI：-0.07，3.82；P=0.0613）。通过进一步的敏感性分析，我们仍然观察到非 ICH 患者中存在很强的相关性（β=0.90，95%CI：0.56，1.24；P<0.001），而在 ICH 患者中则没有相关性（β=1.88，95%CI：-0.10，3.86；P=0.0649）。
我们首次观察到，在没有 ICH 的 CCP 中，HbA1c 升高与 ADL 改善相关，但在有 ICH 的患者中则没有。这一有趣的发现与传统的 HbA1c 升高的不良影响相悖。
