Relationship Between Glycosylated Hemoglobin and Short-Term Mortality of Spontaneous Intracerebral Hemorrhage.

Ping Lu,Yilong Wang,Yu Wang,Liping Liu,Xingquan Zhao,Kaijiang Kang,Hongqiu Gu,Lingyun Cui,Zixiao Li

doi:10.3389/fneur.2021.648907

Abstract

Background: The relationship between glycosylated hemoglobin (HbA1c) and prognosis of spontaneous intracerebral hemorrhage (SICH) patients has not been fully elucidated. This study aimed to reveal the relationship between HbA1c levels and short-term mortality after patient admission with SICH.Methods: It was a large-scale, multicenter, cross-sectional study. From August 1, 2015, to July 31, 2019, a total of 41910 SICH patients were included in the study from the Chinese Stroke Center Alliance (CSCA) program. Finally, we comprehensively analyzed the data from 21,116 patients with SICH. HbA1c was categorized into four groups by quartile. Univariate and multivariate logistic regression analyses were used to assess the association between HbA1c levels and short-term mortality in SICH patients.Results: The average age of the 21,116 patients was 62.8 ± 13.2 years; 13,052 (61.8%) of them were male, and 507 (2.4%) of them died. Compared to the higher three quartiles of HbA1c, the lowest quartile (≤5.10%) had higher short-term mortality. In subgroup analysis with or without diabetes mellitus (DM) patients, the mortality of the Q3 group at 5.60–6.10% was significantly lower than that of the Q1 group at ≤5.10%. After adjustment for potential influencing factors, the ROC curve of HbA1c can better predict the short-term mortality of patients with SICH (AUC = 0.6286 P < 0.001).Conclusions: Therefore, we concluded that low or extremely low HbA1c levels (≤5.10%) after stroke were associated with higher short-term mortality in SICH patients, with or without DM.

Highlights

Spontaneous intracerebral hemorrhage (SICH) accounts for 20–30% of all strokes
Recent studies demonstrated that hyperglycemia is only the result of severe nervous system damage, which may be caused by a stress response, mainly adrenergic stress, and relative insulin deficiency [21, 22]
From August 1, 2015, to July 31, 2019, a total of 1,006,798 patients diagnosed with cerebral hemorrhage, subarachnoid hemorrhage, acute ischemic stroke, or transient ischemic attack were included in the Chinese Stroke Center Alliance (CSCA) program

Summary

Introduction

Spontaneous intracerebral hemorrhage (SICH) accounts for 20–30% of all strokes. As a disabling type of stroke with poor prognosis, SICH contributes to an increase in the global burden of the disease [1, 2]. Recent studies demonstrated that hyperglycemia is only the result of severe nervous system damage, which may be caused by a stress response, mainly adrenergic stress, and relative insulin deficiency [21, 22]. It suggests that blood glucose level measured after the onset of SICH is not an ideal prognostic indicator for stroke patients. The relationship between glycosylated hemoglobin (HbA1c) and prognosis of spontaneous intracerebral hemorrhage (SICH) patients has not been fully elucidated. This study aimed to reveal the relationship between HbA1c levels and short-term mortality after patient admission with SICH

Objectives

Methods

Results

Conclusion