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Quantitative Analysis of Stress-Induced Hyperglycemia and Intracranial Blood Volumes for Predicting Mortality After Intracerebral Hemorrhage

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Abstract

Stress-induced hyperglycemia (SIH) is a neuroendocrine response to acute illness. Although SIH has an adverse association with intracerebral hemorrhage (ICH), quantitative measures and determinants of SIH are not well delineated. In the present study, we objectively evaluated SIH using glycemic gap (GG) and identified its radiological and clinical determinants, with a 5-year retrospective review of charts of ICH patients. We calculated GG using the regression equation (GG = AG −28.7 × HbA1c + 46.7) and evaluated whether GG is an independent predictor of mortality using a multivariate regression model. Radiological volumes of different intracranial compartments were determined using image segmentation software. We correlated GG with different clinical and radiological parameters using Pearson correlation coefficient (PCC), Spearman’s rank correlation (SRC), and Wilcoxon rank sum test. Then, we calculated the value of GG associated with mortality. Out of 328 patients, 238 (73%) survived hospitalization and 90 (27%) expired. GG was found to be an independent predictor of mortality (r=0.008, p=0.04). Additionally, GG was positively correlated with intraparenchymal hemorrhage (IPH) volume (PCC=0.185, p<0.01) and intraventricular hemorrhage (IVH) volume (PCC=0.233, p<0.01) and negatively correlated with cerebrospinal fluid (CSF) volume (PCC=−0.151, p<0.01) and brain tissue volume (PCC=-0.099, p=0.08). GG was positively correlated with patients’ ICH score (SRC=0.377, p<0.01), Glasgow Coma Scale (GCS) (PCC=−0.356, p<0.01), hydrocephalus (p<0.01), and IVH in the third ventricle (p<0.01). The univariate logistic regression model identified 30.0 mg/dl as the value of GG (AUC=0.655, p<0.01) that predicted mortality with 52.2% sensitivity and 75.2% specificity and defined SIH. In conclusion, GG independently predicts mortality in ICH patients and positively correlates with IPH and IVH volumes. However, causality between the two is not established and would require specifically designed studies.

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Availability of Data and Material

All data are available on request.

Code Availability

R 4.0.3

Abbreviations

AG:

Admission glucose

AIS:

Acute ischemic stroke

AUC:

Area under the curve

CT:

Computed tomography

CSF:

Cerebrospinal fluid

CVT:

Cerebral venous thrombosis

EMR:

Electronic medical record

EVD:

External ventricular drain

ICH:

Intracerebral hemorrhage

IPH:

Intraparenchymal hemorrhage

IRB:

Institutional Review Board

IVH:

Intraventricular hemorrhage

mRS:

Modified Rankin Scale

MoCA:

Montreal Cognitive Assessment

PCC:

Pearson correlation coefficient

SRC:

Spearman rank sum

SIH:

Stress-induced hyperglycemia

aSAH:

Aneurysmal subarachnoid hemorrhage

VPS:

Ventriculoperitoneal shunt

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Acknowledgements

Jason Sharps and Kathy Kyler for editing this manuscript

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Authors and Affiliations

  1. Department of Neurology, College of Medicine, University of Oklahoma Health Sciences Center, 920 S.L. Young Blvd #2040, Oklahoma City, OK, 73014, USA

    Claire Delpirou Nouh, David Gordon & Evgeny V. Sidorov

  2. Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Claire Delpirou Nouh, David Gordon & Evgeny V. Sidorov

  3. Physiology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Claire Delpirou Nouh, Bappaditya Ray, Chao Xu, Bin Zheng, Gopichand Danala, Ahmed Koriesh, Kimberly Hollabaugh, David Gordon & Evgeny V. Sidorov

  4. Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA

    Bappaditya Ray

  5. Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Chao Xu & Kimberly Hollabaugh

  6. Electrical Engineering, University of Oklahoma, Norman, OK, USA

    Bin Zheng & Gopichand Danala

  7. Department of Neurology, University of Missouri-Columbia, Springfield, MO, USA

    Ahmed Koriesh

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  1. Claire Delpirou Nouh
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Correspondence to Evgeny V. Sidorov.

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The study was approved by the local IRB office.

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Informed consent was waived because the study is retrospective.

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Claire Delpirou Nouh and Bappaditya Ray contributed equally to the study and are co-first authors of this study.

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Nouh, C.D., Ray, B., Xu, C. et al. Quantitative Analysis of Stress-Induced Hyperglycemia and Intracranial Blood Volumes for Predicting Mortality After Intracerebral Hemorrhage. Transl. Stroke Res. 13, 595–603 (2022). https://doi.org/10.1007/s12975-022-00985-x

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  • DOI: https://doi.org/10.1007/s12975-022-00985-x

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