Exploration and comparison of stress hyperglycemia-related indicators to predict clinical outcomes in patients with spontaneous intracerebral hemorrhage.

Abstract

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.