Zhang Guo-Guo, Zhang Xiao-Dan, Gao Hong-Zhi, Lin Yuan-Xiang, Zheng Zong-Qing
Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian Province, China.
Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, China.
Neurosurg Rev. 2024 Dec 5;47(1):887. doi: 10.1007/s10143-024-03130-4.
Spontaneous intracerebral hemorrhage (ICH) is a prevalent hemorrhagic stroke characterized by a significant fatality rate and severe neurological impairments. Stress hyperglycemia has been confirmed to have a significant prognostic role in a range of diseases. However, studies on the association between stress hyperglycemia and the outcome of ICH have not currently been reported. Critically ill patients diagnosed with ICH in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were included in our study. Logistic regression and Cox regression were used to analyze the correlation between stress hyperglycemia and the outcome of ICH. The predictive ability of different glucose metrics was demonstrated by the receiver-operating characteristic (ROC) curve and was further compared by the integrated discrimination improvement (IDI) index. A total of 880 ICH patients in the MIMIC-IV database were included in this study. In logistic regression and Cox regression, blood glucose level (BGL), glycemic gap (GG), and stress hyperglycemia ratio (SHR) were independent predictors of unfavorable outcomes in ICH after adjustment for other confounders. The IDI results indicated that the 5-day maximum stress hyperglycemia ratio had better predictive performance than glycemic gap and blood glucose level in-hospital mortality and 1-year mortality, and the predictive performance of the 5-day maximum stress hyperglycemia ratio was better than that of stress hyperglycemia ratio measured at admission. In the age-stratified subgroup analysis, the 5-day maximum stress hyperglycemia ratio was more sensitive in predicting long-term outcomes in the young subgroup than in the elderly subgroup. The 5-day maximum stress hyperglycemia ratio is strongly correlated with an elevated risk of mortality in ICH patients and displays a better predictive ability than glycemic gap and blood glucose level in the short/long-term prognosis of ICH.
自发性脑出血（ICH）是一种常见的出血性中风，具有较高的死亡率和严重的神经功能障碍。应激性高血糖已被证实在一系列疾病中具有重要的预后作用。然而，目前尚未有关于应激性高血糖与ICH预后之间关联的研究报道。我们的研究纳入了医学重症监护信息集市IV（MIMIC-IV）数据库中诊断为ICH的重症患者。采用逻辑回归和Cox回归分析应激性高血糖与ICH预后之间的相关性。通过受试者工作特征（ROC）曲线展示不同血糖指标的预测能力，并通过综合判别改善（IDI）指数进行进一步比较。本研究共纳入了MIMIC-IV数据库中的880例ICH患者。在逻辑回归和Cox回归中，调整其他混杂因素后，血糖水平（BGL）、血糖差值（GG）和应激性高血糖比率（SHR）是ICH不良预后的独立预测因素。IDI结果表明，5天最大应激性高血糖比率在预测住院死亡率和1年死亡率方面比血糖差值和血糖水平具有更好的预测性能，且5天最大应激性高血糖比率的预测性能优于入院时测量的应激性高血糖比率。在年龄分层亚组分析中，5天最大应激性高血糖比率在预测年轻亚组的长期预后方面比老年亚组更敏感。5天最大应激性高血糖比率与ICH患者死亡率升高密切相关，并且在ICH的短期/长期预后中比血糖差值和血糖水平显示出更好的预测能力。
