自发性脑出血的应激性高血糖指标与早期神经功能恶化

Stress hyperglycemia indexes and early neurological deterioration in spontaneous intracerebral hemorrhage.

作者信息

Currò Carmelo Tiberio, Ferrari Federica, Merlino Giovanni, Moraru Stefan, Bax Francesco, Kuris Fedra, Nesi Lorenzo, Valente Mariarosaria, Ballante Elena, d'Altilia Nicola, Rascunà Cristina, Morotti Andrea, Mazzacane Federico, Cavallini Anna Maria

机构信息

Department of Brain and Behavioural Sciences, University of Pavia, Viale Golgi 19, Pavia, 27100, Italy.

Department of Cerebrovascular Disease/Stroke Unit, IRCCS Mondino Foundation, Via Mondino 2, Pavia, 27100, Italy.

出版信息

Neurol Sci. 2025 Mar 19. doi: 10.1007/s10072-025-08097-8.

DOI:10.1007/s10072-025-08097-8

PMID:40106104

Abstract

AIM

To evaluate the relationship of early neurological deterioration (END) with admission glycemia (aG) and new stress hyperglycemia indexes in spontaneous intracerebral hemorrhage (ICH) patients.

METHODS

The present retrospective study included 171 ICH patients from two stroke centers. END was defined as an increase ≥ 4 points in National Institutes of Health Stroke Scale and/or a decrease ≥ 2 points in Glasgow Coma Scale within 72 hours from admission. The included stress hyperglycemia indexes were glycemic gap (GGAP), stress hyperglycemia ratio (SHR), and glucose-glycated hemoglobin ratio. GGAP was calculated as aG - 28,7glycated hemoglobin + 46,7; SHR as aG / (28,7glycated hemoglobin - 46,7); Glucose-glycated hemoglobin ratio as aG / glycated hemoglobin. We performed univariate and multivariate analyses for END. The receiver operating characteristic curves were built for END-related glycemic measures; area under curves (AUC) were calculated and compared. The optimized threshold values were calculated, and significant glycemic measures were dichotomized. Univariate and multivariate analyses were performed for the dichotomized measures.

RESULTS

END was present in 21 patients (12.3%) and was significantly associated with GGAP, SHR and glucose-glycated hemoglobin ratio, but not with aG. The AUC of the three stress hyperglycemia indexes did not differ significantly. The optimized cutoffs were 35.68 (sensitivity 0.47, specificity 0.81), 1.15 (sensitivity 0.62, specificity 0.68), and 26.67(sensitivity 0.43, specificity 0.80) for GGAP, SHR, and glucose-glycated hemoglobin ratio respectively. END was also associated with all stress hyperglycemia indexes expressed as categorical variables.

CONCLUSION

GGAP, SHR, and glucose-glycated hemoglobin ratio were predictors of END in ICH patients.

摘要

目的

评估自发性脑出血（ICH）患者早期神经功能恶化（END）与入院血糖（aG）及新的应激性高血糖指标之间的关系。

方法

本回顾性研究纳入了来自两个卒中中心的171例ICH患者。END定义为入院后72小时内美国国立卫生研究院卒中量表评分增加≥4分和/或格拉斯哥昏迷量表评分降低≥2分。纳入的应激性高血糖指标有血糖差值（GGAP）、应激性高血糖比率（SHR）和血糖糖化血红蛋白比率。GGAP计算为aG - 28.7×糖化血红蛋白 + 46.7；SHR计算为aG /（28.7×糖化血红蛋白 - 46.7）；血糖糖化血红蛋白比率计算为aG /糖化血红蛋白。我们对END进行了单因素和多因素分析。构建了与END相关的血糖指标的受试者工作特征曲线；计算并比较曲线下面积（AUC）。计算了优化阈值，并将有显著意义的血糖指标进行二分法分类。对二分法分类的指标进行了单因素和多因素分析。

结果

21例患者（12.3%）出现END，且与GGAP、SHR和血糖糖化血红蛋白比率显著相关，但与aG无关。三个应激性高血糖指标的AUC差异无统计学意义。GGAP、SHR和血糖糖化血红蛋白比率的优化截断值分别为35.68（敏感性0.47，特异性0.81）、1.15（敏感性0.62，特异性0.68）和26.67（敏感性0.43，特异性0.80）。END也与以分类变量表示的所有应激性高血糖指标相关。