| PART 1 Establishment of ADVISING scoring scale for predicting the outcome of spontaneous cerebral hemorrhage based on multi-system injury and response factors AimSpontaneous cerebral hemorrhage(ICH)is one of the stroke types with the highest disability and mortality rates,often accompanied by secondary damage to other systems throughout the body.Currently,there is a lack of warning models based on multi-system injury and response factors to predict adverse outcomes in patients.Therefore,the aim of this study is to develop a new clinical predictive scoring scale that combines patient multisystem injury and response factors to predict 90-day functional outcomes in patients with spontaneous cerebral hemorrhage.MethodsBased on the data of the Chinese Cerebral Hemorrhage:Mechanisms and Intervention Study(CHEERY)cohort study,this study collected baseline data of ICH patients who met the inclusion criteria,including age,gender,medical history(including cerebral infarction,ischemic heart disease,hypertension,diabetes,hyperlipidemia),modified Rankin scale(mRS)Admitted systolic blood pressure(SBP),National Institutes of Health Stroke Scale(NIHSS)at onset,hematoma location,hematoma volume,intraventricular hemorrhage(IVH),white blood cell(WBC),hemoglobin(Hb),platelet(PLT)Neutrophil to lymphocyte ratio(NLR),alanine transaminase(ALT),aspartate transaminase(AST),creatinine(Cr),uric acid(UA),fasting blood glucose(FBG),international normalized ratio(INR),Glomerular filtration rate(GFR)and mRS score at 90 days.A total of 2844 ICH patients were enrolled,with 2111 patients from Hubei Province identified as the training cohort,and 733 patients from other provinces in China were identified as the validation cohort.The 2111 patients in the training cohort were grouped based on the 90-day mRS score and prognosis,and the univariate differences between the groups were compared(mRS<3 indicates good prognosis,mRS≥3 indicates poor prognosis).The next step is to include significant differences(p<0.05)in univariate logistic regression analysis,identify independent risk factors related to the 90-day adverse prognosis(mRS≥3)of ICH patients in the training cohort,and the ADVISING scale was developed according to the predictive weight of each independent risk factor on the 90-day poor outcome.At the same time,the reliability of the ADVISING scale was verified in the validation cohort.Finally,compare the ADVISING scale with the existing five scoring scales in terms of distinguishing ability.ResultsThe univariate analysis results of the modeling queue showed that the patient’s age≥60 years,SBP≥180 mmHg,admission NIHSS score,hematoma location,hematoma volume≥30 mL,and WBC>10×109/L,Hb<120 g/L,NLR>10,AST>40 U/L,GFR<90 mL/min/1.73m2,FBG≥7.0 mmol/L,INR≥1.2 are significantly associated with poor prognosis in ICH patients.Multivariate regression analysis of the training cohort showed that a total of 9 variables were independently related to the 90-day poor outcome of ICH patients,including age,hematoma location,bleeding volume,National Institutes of Health Stroke Scale(NIHSS),aspartate transaminase(AST)>40 U/L,international normalized ratio(INR)≥1.2,neutrophil-lymphocyte ratio(NLR)>10,fasting blood glucose(FBG)≥7.0 mmol/L,glomerular filtration rate(GFR)<90 mL/min/1.73m2.These 9 variables were included in the ADVISING scale(total score 0～12):age≥60 years(1 point),deep hemorrhage(1 point),hematoma volume 30～60 ml(1 point),hematoma volume>60 mL(2 points),NIHSS score 4～5(1 point),NIHSS score 6～14(2 points),NIHSS score 15～40(3 points),AST>40 U/L(1 point),INR≥1.2(1 point),NLR>10(1 point),FBG≥7.0 mmol/L(1 point)and GFR<90 mL/min/1.73m2(1 point).The proportion of patients with 90-day poor outcome of onset increased with the increase of the ADVISING score and the ADVISING score showed good discrimination and calibration in the training cohort(C statistic,0.866;p=0.195)and the validation cohort(C statistic,0.884;p=0.853).Finally,the ADVISING score was compared with the five existing ICH scores(MICH,ICHOP,original ICH,ICHGS,and ICH-FOS),and the results showed that the scale had the better predictive ability(Delong test,p<0.001).ConclusionsADVISING score is a reliable tool to predict the 90-day poor outcome after ICH.PART 2 Stress-induced hyperglycemia is an independent risk factor for poor outcomes of spontaneous intracerebral hemorrhageAimThe correlation between the admission of hyperglycemia and the adverse outcome of patients with intracerebral hemorrhage(ICH)is controversial,and it is not clear whether pre-existing diabetes mellitus(DM)affects the prognosis of patients.The purpose of this study is to explore the impact of admission hyperglycemia and whether there is DM on the prognosis of patients,so as to identify patients with poor outcomes as soon as possible,provide help for doctors to make treatment decisions,and then improve the prognosis of patients.Methods1372 patients from the Chinese Cerebral Hemorrhage:Mechanisms and Intervention Study(CHEERY)were divided into two groups according to admission blood glucose.Compare the differences between groups in age,gender,hypertension and DM history,time from onset to admission,admission systolic blood pressure(SBP)and Glycosylated Hemoglobin A1C(HBAlc),infratentorial hemorrhage,bleeding volume,intraventricular hemorrhage(IVH),The Glasgow Coma Scale(GCS),surgical treatment,length of hospital stay,30-day and 90-day Modified Rankin Scale(mRS).The index with a significant difference was included in the modified Poisson regression models for analysis,and the correlation between admission hyperglycemia and lung infection,hospital death,30-day and 90-day poor outcome(mRS 3-6),and 30-day and 90-day death was explored.Patients were divided into the following four groups:Non-DM with normal blood glucose(NDN),DM with normal blood glucose(DN),DM with hyperglycemia(DH),and stress-induced hyperglycemia(SIH).Multivariate regression analysis was performed on significantly different indicators(age,sex,history of hypertension,time from symptom onset to admission,infratentorial hemorrhage,bleeding volume,GCS,IVH,and surgical treatment)to compare the differences between different groups in pulmonary infection,hospital death,30-day and 90-day poor outcomes(mRS 3-6),and 30-day and 90-day death.Results1372 patients were included in totally,including 904(65.9%)males,984 patients with admission blood glucose<7.8 mmoL,and 388 patients≥7.8 mmoL.The results showed that the patients with admission hyperglycemia have higher HbAlc(p<0.001),a higher proportion of hypertension(p=0.002)and DM(p<0.001),a shorter time of admission to the hospital(p=0.012),more infratentorial hemorrhage(p<0.001)and IVH(p<0.001),lower GCS score(p<0.001),and more patients underwent surgical treatment(p<0.001).In addition,compared with admission hypoglycemia patients,admission hyperglycemia patients had a 1.403-fold higher risk of lung infection(RR 1.403,95%CI:1.066-1.846),a 1.038-fold higher risk of 30-day poor outcome(RR 1.038,95%CI:1.003-1.074),a 1.145fold higher risk of 90-day poor outcome(RR 1.145,95%CI:1.025-1.279),and a 1.041-fold higher risk of 30-day death(RR 1.041,95%CI:1.005-1.077).Of the 1372 patients,826 were classified as NDN group,158 as DN group,149 as SIH group,and 239 as DH group.Compared with the NDN group,the patients in the SIH group had a 1.477-fold higher risk of lung infection(RR 1.477,95%CI:1.004-2.172),a 1.068-fold higher risk of 30-day death(RR 1.068,95%CI:1.009-1130),and a 1.060-fold higher risk of 90-day death(RR 1.060,95%CI:1.000-1.124).However,DN and DH did not affect the outcomes.ConclusionsAdmission hyperglycemia is very common in ICH patients,and admission hyperglycemia significantly increases the risk of lung infection,30-day and 90-day poor outcomes,and 30-day death.SIH,rather than DH,is an independent risk factor for the increased risk of lung infection and 30-day and 90-day death in ICH patients.Early identification of SIH patients and timely treatment may be a potential treatment method to improve the outcome of ICH patients. |
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