Correlation Between Blood Glucose Variability And Prognosis In Patients With Acute Severe Cerebrovascular Disease

Objective: Cerebrovascular disease is a common and frequently-occurring disease in middle-aged and elderly people.It has the characteristics of high incidence,high mortality,high recurrence rate and high disability rate,which seriously threatens human health and brings social economy and world health system.Heavy burden,therefore,how to reduce the occurrence of stroke and improve the prognosis of stroke has become the focus of research in the whole society.Glucose variability refers to the unsteady state of blood glucose levels fluctuating between peak and trough.Critically ill patients are affected by a variety of factors,and blood glucose variability is significantly increased.Recent studies have confirmed blood glucose variability and patient prognosis.Significant correlation,it is an important prognostic factor that can independently predict the death of critically ill patients.In order to further study the relationship between blood glucose variability and the prognosis of critically ill patients in neurology,this study used patients with acute severe cerebrovascular disease in the intensive care unit(N-ICU)of our hospital to study the variability of blood glucose and the acute severe brain of neurology.The correlation of prognosis in patients with vascular disease,how to effectively perform blood glucose intervention and improve the prognosis of patients.Method: A total of 126 patients with acute severe cerebrovascular disease in the intensive care unit of the Department of Neurology,Affiliated Hospital of Hebei University(January 2017-October 2018)were selected.According to the 28 d prognosis,the patients were divided into the death group and the survival group.The gender,age,presence or absence of diabetes,hypertension,hyperlipidemia,coronary heart disease,smoking and drinking history,Glasgow score,NIHSS score,and acute physiology and chronic health assessment II(APACHE II)scores were recorded for each patient.All blood glucose test results of each patient within 24 hours of admission were recorded in the order of blood sample collection.Blood glucose variability is measured by initial blood glucose,mean blood glucose,standard deviation,and coefficient of variation.The correlation between blood glucose variability in death and survival groups and the risk of death in patients with acute severe cerebrovascular disease was compared.Results: A total of 126 patients were included in the study,including 102 in the survival group and 24 in the death group.A total of 38 patients with cerebral hemorrhage and 88 patients with cerebral infarction were collected.There was no significant difference in the diagnosis between the two groups.The mean age of the patients was over 60 years old,the average age of the survival group was 62.90±11.84 years old,and the average age of the death group was 69.92±10.33 years old.There was no significant difference in age between the two groups.The gender of both groups was mainly male,and the difference in gender distribution between the two groups was not significant.There was no significant difference in the prevalence of diabetes,hypertension,hyperlipidemia and coronary heart disease between the survival group and the death group(P>0.05).There was no significant difference in smoking or drinking between the two groups.The GCS score of the survival group was 7.90 ± 2.88,which was higher than that of the death group by 4.83 ± 1.99,and the difference was statistically significant(P < 0.05).The NIHSS score of the surviving group was 17.53±2.64,which was lower than the NIHSS score of the death group(27.75±4.37),and the difference was statistically significant(P<0.001).The APACHE II score of the survival group was 14.75±5.20,which was lower than that of the death group(22.50±5.04),and the difference was statistically significant(P<0.001).The initial blood glucose of the survival group was 7.33±2.01mmol/L,and the initial blood glucose of the death group was 8.10±2.00mmol/L.There was no significant difference in the initial blood glucose between the two groups(P>0.05).The mean,standard deviation and coefficient of variation of the patient's 24 h blood glucose results were calculated.The results showed that there was no significant difference in mean blood glucose between the survival group and the death group.However,the difference of blood glucose standard(1.52±0.50mmol/L)and coefficient of variation(0.20±0.04)in the survival group were significantly lower than those in the death group,and the difference was statistically significant(P<0.001).The NIHSS score,APACHE II score and blood glucose coefficient of variation were included in the multivariate logistic model.After controlling for other confounding factors,the risk of death increased with the increase of NIHSS score(O=2.218,P=0.002),indicating that the NIHSS score is affected.Risk factors for prognosis of patients;with the increase of APACHE II score,the risk of death increased(OR=1.327,P=0.001),indicating that APACHE II score is also a risk factor affecting the prognosis of patients.The greater the patient's glycemic coefficient of variation,the greater the risk of death(OR=10.641,P=0.002).Conclusion: The variability of blood glucose is significantly correlated with the 28-day mortality rate of patients with acute severe cerebrovascular disease,and the standard deviation and coefficient of variation of blood glucose are more valuable than the average blood glucose.At the same time,NIHSS score,APACHE II score and blood glucose coefficient of variation are risk factors for evaluating prognosis.Glucose variability can be used to evaluate the severity and prognosis of patients with critically ill cerebrovascular disease as well as APACHE II score.