U−shaped association between the glycemic variability and prognosis in hemorrhagic stroke patients: a retrospective cohort study from the MIMIC-IV database

 Useless, describes a problem; provides NO solution!

U−shaped association between the glycemic variability and prognosis in hemorrhagic stroke patients: a retrospective cohort study from the MIMIC-IV database

Yuchen Liu^1†Houxin Fu^2†Yue Wang³Jingxuan Sun¹Rongting Zhang¹Yi Zhong¹Tianquan Yang¹Yong Han¹Yongjun Xiang¹Bin Yuan¹Ruxuan Zhou¹Min Chen¹Hangzhou Wang^1*

• ¹Department of Neurosurgery, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
• ²Department of Pediatric Hematology and Oncology, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
• ³Institute of Pediatric Research, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China

Background: Elevated glycemic variability (GV) is commonly observed in intensive care unit (ICU) patients and has been associated with clinical outcomes. However, the relationship between GV and prognosis in ICU patients with hemorrhagic stroke (HS) remains unclear. This study aims to investigate the association between GV and short- and long-term all-cause mortality.

Methods: Clinical data for hemorrhagic stroke (HS) patients were obtained from the MIMIC-IV 3.1 database. GV was quantified using the coefficient of variation (CV), calculated as the ratio of the standard deviation to the mean blood glucose level. The association between GV and clinical outcomes was analyzed using Cox proportional hazards regression models. Additionally, restricted cubic spline (RCS) curves were employed to examine the nonlinear relationship between GV and short- and long-term all-cause mortality.

Results: A total of 2,240 ICU patients with HS were included in this study. In fully adjusted models, RCS analyses revealed a U-shaped association between the CV and both short- and long-term all-cause mortality (P for nonlinearity < 0.001 for all outcomes). Two-piecewise Cox regression models were subsequently applied to identify CV thresholds. The thresholds for all-cause mortality in ICU, during hospitalization, and at 30, 90, and 180 days were determined to be 0.14, 0.16, 0.155, 0.14, and 0.14, respectively. These findings were consistent in sensitivity and subgroup analyses.

Conclusions: In HS patients, higher GV is associated with an increased risk of both short- and long-term all-cause mortality. Our findings suggest that stabilizing GV may improve the prognosis of HS patients.(Where the fuck is the protocol that does that? Your mentors and senior researchers need to be fired for incompetency?)

Background

Cerebrovascular disease (CVD) is the second leading cause of death worldwide, surpassed only by cardiovascular disease (1–3). Stroke, a major component of CVD, has been identified by the World Health Organization as the primary cause of long-term disability globally (4, 5). Although hemorrhagic stroke (HS) accounts for only 10–20% of all stroke cases, it is responsible for nearly half of all stroke-related deaths (6, 7). With an aging global population, the burden of stroke continues to rise, with HS patients in intensive care units (ICU) facing an elevated mortality risk (8). Consequently, identifying prognostic markers for predicting adverse outcomes in HS patients is essential. Historically, assessment tools such as the NIH Stroke Scale and the Canadian Neurological Scale have been widely utilized (9). Despite their utility, these scales are limited by their complexity, time requirements, and the need for specialized training.

Recently, glycemic variability (GV), a parameter of glycemic control, has emerged as a potential factor influencing the progression of cardiovascular and cerebrovascular conditions (10–13). GV reflects fluctuations in blood glucose levels relative to the mean and represents a key pattern of glycemic dysregulation observed in critically ill patients. Compared to persistent hyperglycemia, pronounced glycemic variability has been demonstrated to exacerbate endothelial dysfunction and trigger oxidative stress, potentially leading to more severe cerebrovascular damage (14–16). Moreover, both hyperglycemia and hypoglycemia were recognized as significant factors influencing stroke prognosis (16). Despite this, the impact of glycemic variability on HS patients has been understudied and remains a topic of debate in clinical practice (17, 18).

To address this gap, the present study examined the association between glycemic variability and short-term and long-term all-cause mortality in HS patients. The findings aimed to support clinicians in identifying high-risk individuals, facilitating closer monitoring and timely therapeutic interventions.

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Glycemic variability of acute stroke patients and clinical outcomes: a continuous glucose monitoring study

 So how do we prevent glycemic variability? WHOM is going to answer that question? With NO STROKE LEADERSHIP, nothing will occur.

Don't just tell us there is a problem, SOLVE THE FUCKING PROBLEM! I'd be fired in no time if I never solved the problems I found.

Glycemic variability of acute stroke patients and clinical outcomes: a continuous glucose monitoring study

 

Show all authors

Lina Palaiodimou, Vasileios-Arsenios Lioutas, Vaia Lambadiari, ...

First Published September 22, 2021 Research Article 

https://doi.org/10.1177/17562864211045876

Article information

Abstract

Introduction:

Glycemic variability (GV) has been associated with worse prognosis in critically ill patients. We sought to evaluate the potential association between GV indices and clinical outcomes in acute stroke patients.

Methods:

Consecutive diabetic and nondiabetic, acute ischemic or hemorrhagic stroke patients underwent regular, standard-of-care finger-prick measurements and continuous glucose monitoring (CGM) for up to 96 h. Thirteen GV indices were obtained from CGM data. Clinical outcomes during hospitalization and follow-up period (90 days) were recorded. Hypoglycemic episodes disclosed by CGM but missed by finger-prick measurements were also documented.

Results:

A total of 62 acute stroke patients [48 ischemic and 14 hemorrhagic, median NIHSS score: 9 (IQR: 3–16) points, mean age: 65 ± 10 years, women: 47%, nondiabetic: 79%] were enrolled. GV expressed by higher mean absolute glucose (MAG) values was associated with a lower likelihood of neurological improvement during hospitalization before and after adjusting for potential confounders (OR: 0.135, 95% CI: 0.024–0.751, p = 0.022). There was no association of GV indices with 3-month clinical outcomes. During CGM recording, 32 hypoglycemic episodes were detected in 17 nondiabetic patients. None of these episodes were identified by the periodic blood glucose measurements and therefore they were not treated.

Conclusions:

Greater GV of acute stroke patients may be related to lower odds of neurological improvement during hospitalization. No association was disclosed between GV indices and 3-month clinical outcomes.

Keywords

acute stroke, clinical outcomes, continuous glucose monitoring, glycemic variability, hypoglycemic episodes, neurological improvement

Introduction

Poststroke hyperglycemia is a common phenomenon in the acute setting of stroke and has been considered an independent predictor of poor clinical outcomes in both ischemic and hemorrhagic stroke.^1–6 Thus, hyperglycemia management with intensive treatment had been expected to improve clinical outcomes. Despite the initial enthusiasm, randomized controlled clinical trials did not confirm the safety and efficacy of such treatment approaches.^7,8 On the contrary, aggressive protocols with intravenous insulin infusions significantly increased the risk of hypoglycemia, which has been related to adverse functional outcomes in patients with acute ischemic stroke.⁹

By focusing strictly on hyperglycemia and hypoglycemia, however, we might have been overlooking a third independent component of dysglycemia: glycemic variability (GV), which is defined as the degree of fluctuation in glucose values over time.¹⁰ GV has been correlated with higher mortality risk in critically ill patients, even when mean glucose values are within normal limits.^11,12 GV has been consistently overlooked in relevant randomized controlled clinical trials, although it may be a key reason why intensive glycemic control has failed to demonstrate significant clinical benefit in stroke patients.^13,14 In recent years, there has been a growing interest regarding the role of GV in stroke outcomes in several observational studies.^15–21 Those studies, however, are relatively limited either by the lack of continuous glucose monitoring (CGM) data or by the assessment of only a proportion of the existing GV indices.²²

In this prospective, cohort study, we examined the association between GV and clinical outcomes in consecutive diabetic and nondiabetic, ischemic, and hemorrhagic acute stroke patients using CGM and calculated GV by measuring 13 different qualitative and quantitative indices. We hypothesized that increased GV in the acute stroke setting is associated with adverse short- and long-term clinical outcomes.

Glycemic variability of acute stroke patients and clinical outcomes: a continuous glucose monitoring study

So you described a problem, offered no solution. Useless. Do your mentors and senior researchers know that the only goal in stroke is 100% recovery? This does nothing for that.

Glycemic variability of acute stroke patients and clinical outcomes: a continuous glucose monitoring study

Show all authors

Lina Palaiodimou, Vasileios-Arsenios Lioutas, Vaia Lambadiari, ...

First Published September 22, 2021 Research Article 

https://doi.org/10.1177/17562864211045876

Article information

Abstract

Introduction:

Glycemic variability (GV) has been associated with worse prognosis in critically ill patients. We sought to evaluate the potential association between GV indices and clinical outcomes in acute stroke patients.

Methods:

Consecutive diabetic and nondiabetic, acute ischemic or hemorrhagic stroke patients underwent regular, standard-of-care finger-prick measurements and continuous glucose monitoring (CGM) for up to 96 h. Thirteen GV indices were obtained from CGM data. Clinical outcomes during hospitalization and follow-up period (90 days) were recorded. Hypoglycemic episodes disclosed by CGM but missed by finger-prick measurements were also documented.

Results:

A total of 62 acute stroke patients [48 ischemic and 14 hemorrhagic, median NIHSS score: 9 (IQR: 3–16) points, mean age: 65 ± 10 years, women: 47%, nondiabetic: 79%] were enrolled. GV expressed by higher mean absolute glucose (MAG) values was associated with a lower likelihood of neurological improvement during hospitalization before and after adjusting for potential confounders (OR: 0.135, 95% CI: 0.024–0.751, p = 0.022). There was no association of GV indices with 3-month clinical outcomes. During CGM recording, 32 hypoglycemic episodes were detected in 17 nondiabetic patients. None of these episodes were identified by the periodic blood glucose measurements and therefore they were not treated.

Conclusions:

Greater GV of acute stroke patients may be related to lower odds of neurological improvement during hospitalization. No association was disclosed between GV indices and 3-month clinical outcomes.

Keywords

acute stroke, clinical outcomes, continuous glucose monitoring, glycemic variability, hypoglycemic episodes, neurological improvement

Introduction

Poststroke hyperglycemia is a common phenomenon in the acute setting of stroke and has been considered an independent predictor of poor clinical outcomes in both ischemic and hemorrhagic stroke.^1–6 Thus, hyperglycemia management with intensive treatment had been expected to improve clinical outcomes. Despite the initial enthusiasm, randomized controlled clinical trials did not confirm the safety and efficacy of such treatment approaches.^7,8 On the contrary, aggressive protocols with intravenous insulin infusions significantly increased the risk of hypoglycemia, which has been related to adverse functional outcomes in patients with acute ischemic stroke.⁹

By focusing strictly on hyperglycemia and hypoglycemia, however, we might have been overlooking a third independent component of dysglycemia: glycemic variability (GV), which is defined as the degree of fluctuation in glucose values over time.¹⁰ GV has been correlated with higher mortality risk in critically ill patients, even when mean glucose values are within normal limits.^11,12 GV has been consistently overlooked in relevant randomized controlled clinical trials, although it may be a key reason why intensive glycemic control has failed to demonstrate significant clinical benefit in stroke patients.^13,14 In recent years, there has been a growing interest regarding the role of GV in stroke outcomes in several observational studies.^15–21 Those studies, however, are relatively limited either by the lack of continuous glucose monitoring (CGM) data or by the assessment of only a proportion of the existing GV indices.²²

In this prospective, cohort study, we examined the association between GV and clinical outcomes in consecutive diabetic and nondiabetic, ischemic, and hemorrhagic acute stroke patients using CGM and calculated GV by measuring 13 different qualitative and quantitative indices. We hypothesized that increased GV in the acute stroke setting is associated with adverse short- and long-term clinical outcomes.