Study Correlation Between Glycemic Trajectory During The Acute Phase Of Spontaneous Intracerebral Hemorrhage And 90-day Functional Outcome

Objective We aimed to elucidate the association between glycemic trajectory during the acute phase of spontaneous intracerebral hemorrhage and 90-day functional outcome and provide clinical evidence for the formulation of management strategy.Methods We retrospectively studied the patients in department of neurology from January 2016 to January 2018 admitted with spontaneous intracerebral hemorrhage.All patients had glucose measurements at least once between both 0 to 24 and 24 to 72 hours from onset.Hyperglycemia was defined as blood glucose ≥10 mmol/L based on the Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018.Glycemic trajectory was defined on maximum values 0 to 24 and 24 to 72 hours after ICH:(1)persistent normoglycemia in both epochs;(2)early hyperglycemia(only before 24 hours);(3)late hyperglycemia(only between 24 and 72 hours);and(4)persistent hyperglycemia in both epochs.Age,sex,hypertension,type 2 diabetes mellitus,smoking,drinking,admission blood pressure,nasogastric tube feeding,hematoma volumes,ventricular extension,baseline NIHSS,baseline GCS,evidence of infection and some laboratory parameters were recorded.According to the functional outcomes of patients at 90 days,the patients were divided into two groups with good outcomes(Modified Rankin Score(mRS)≤ 2)or poor outcomes(mRS>2).We compared the baseline status during hospitalization between the two groups.Logistic regression with known predictors of outcome estimated the association of glycemic trajectory and 90-day functional outcome.A P value of <0.05 was considered significant.Results(1)Of the 247 patients in the analysis,96(38.9%)had persistent normoglycemia,60(24.3%)early only hyperglycemia,20(8.1%)late only hyperglycemia and 71(28.7%)persistent hyperglycemia.In 131(53.0%)patients with hyperglycemia within 24 hours of ictus,71(54.2%)remained persistently hyperglycemic.The glycemic trajectory groups differed by presence of diabetes mellitus,baseline NIHSS,rate of infection,nasogastric tube feeding and ventricular extension.The 90-day functional outcome also differed between different glycemic trajectory groups on univariate analysis(P<0.05).(2)In our study,we selected 247 patients together,there are 159(64.4%)patients in the group of good outcome and 88(35.6%)patients in the group of poor outcome.The factors associated with poor outcome on univariate analysis were older age,nasogastric tube feeding,lower GCS,higher NIHSS,evidence of infection,higher hematoma volumes,ventricular extension and different glycemic trajectory groups(P<0.05).Sex,hypertension,type 2 diabetes mellitus,smoking,drinking,admission blood pressure and blood lipid components were not associated with the poor outcome(P>0.05).(3)In the multivariable logistic regression model,persistent hyperglycemia was associated with the poor outcome at 90 days(OR=2.627,95%CI 1.286-5.369)adjusted for age,nasogastric tube feeding,type 2 diabetes mellitus and baseline GCS.In addition,baseline NIHSS,hematoma volumes,ventricular extension and evidence of infection were independent risk factors of the poor outcome.Conclusion(1)Persistent normoglycemia,early only hyperglycemia,late only hyperglycemia were not associated with the poor outcome at 90 days after spontaneous intracerebral hemorrhage.(2)Persistent hyperglycemia was significantly associated with the poor outcome at 90 days after spontaneous intracerebral hemorrhage.We should pay attention to early blood glucose management in clinical work to reduce the possibility of adverse functional prognosis.(3)Baseline NIHSS,hematoma volumes,ventricular extension and evidence of infection were independent risk factors of the poor outcome.