Abstract Details

Title Glycemic Gap Predicts In-hospital Mortality in Intracerebral Hemorrhage Patients

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) Neurocritical Care Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 001

Objective To evaluate the association between glycemic gap (GG) and in-hospital mortality in patients with intracerebral hemorrhage (ICH)

Background The relationship between admission hyperglycemia and ICH outcome is still controversial. Glycemic levels before stroke occurrence should be also considered when investigating the association of stress-induced hyperglycemia with prognosis. The GG reflects ‘‘additional’’ glucose homeostasis in response to physical stress on chronic glycemic control.

Design/Methods We retrospectively identified consecutive patients hospitalized for spontaneous ICH at the 2 healthcare systems in the Twin Cities area, MN, between January 2008 and December 2017. Demographics, medical history, admission tests and computed tomography data were recorded. The glycosylated hemoglobin (HbA1c) levels were converted to the glycosylated hemoglobin (HbA1c)-derived average glucose (ADAG) defined as: ADAG=[(28.7*HbA1c)-46.7]. GG was then calculated from the glucose level minus ADAG. The association between GG and in-hospital mortality was evaluated by Cox regression analysis. Receiver operating characteristic (ROC) analysis was used to evaluate the ability of GG to predict in-hospital death.

Results Among 345 patients with available HbA1c levels, 63 (25.7%) died during their hospital stay. Non-survivors presented at admission with significantly higher Glasgow coma scale score and larger hematoma volume. They also had higher white blood cells count, glucose, and GG levels than survivors (p<0.001). Using Cox regression analysis, the GG resulted an independent predictor of in-hospital mortality after adjusting for potential confounders [hazard ratio: 1.005, 95% CI 1.001-1.009; p=0.021]. The GG showed a good discriminative power (area under the ROC curve: 0.75, 95% CI 0.68-0.82; p<0.001) and outperformed the admission glucose level as a predictor of in-hospital death.

Conclusions The GG is associated with the risk of in-hospital mortality and can represent a simple tool to assess the prognosis of patients with acute ICH. Routine HbA1c tests should be performed in ICH patients to better elucidate this association.

Authors/Disclosures
Afshin A. Divani, PhD (University of New Mexico) PRESENTER	The institution of Dr. Divani has received research support from Department of Defense.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Mario Di Napoli, MD (ASL Rieti)	Dr. Di Napoli has nothing to disclose.
Michel T. Torbey, MD, MPH, FAAN (University of New Mexico)	Dr. Torbey has nothing to disclose.

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