Association Between Glycemic Gap and In-hospital Outcomes in Aneurysmal Subarachnoid Hemorrhage

Introduction: Glycemic gap (GG), as determined by the difference between glucose and the hemoglobin A1c (HbA1c)-derived estimated average glucose (eAG), is associated with poor outcomes in various clinical settings. There is a paucity of data describing GG and outcomes after aneurysmal subarachnoid...

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Autores principales:	Philip Y. Sun, Roy A. Poblete, Peggy L. Nguyen, Sebina F. Bulic, May A. Kim-Tenser, Jonathan Marehbian, Steven Y. Cen, Benjamin A. Emanuel
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	aneurysmal subarachnoid hemorrhage hyperglycemia glycemic gap outcomes mortality Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/ffeed506c4ee4ce1b86625f0ad4e98bc
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spelling	oai:doaj.org-article:ffeed506c4ee4ce1b86625f0ad4e98bc2021-11-30T11:27:20ZAssociation Between Glycemic Gap and In-hospital Outcomes in Aneurysmal Subarachnoid Hemorrhage1664-229510.3389/fneur.2021.714341https://doaj.org/article/ffeed506c4ee4ce1b86625f0ad4e98bc2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fneur.2021.714341/fullhttps://doaj.org/toc/1664-2295Introduction: Glycemic gap (GG), as determined by the difference between glucose and the hemoglobin A1c (HbA1c)-derived estimated average glucose (eAG), is associated with poor outcomes in various clinical settings. There is a paucity of data describing GG and outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Our main objectives were to evaluate the association of admission glycemic gap (aGG) with in-hospital mortality and with poor composite outcome and to compare aGG's predictive value to admission serum glucose. Secondary outcomes were the associations between aGG and neurologic complications including vasospasm and delayed cerebral ischemia following aSAH.Methods: We retrospectively reviewed 119 adult patients with aSAH admitted to a single tertiary care neuroscience ICU. Spearman method was used for correlation for non-normality of data. Area under the curve (AUC) for Receiver Operating Characteristic (ROC) curve was used to estimate prediction accuracy of aGG and admission glucose on outcome measures. Multivariable analyses were conducted to assess the value of aGG in predicting in-hospital poor composite outcome and death.Results: Elevated aGG at or above 30 mg/dL was identified in 79 (66.4%) of patients. Vasospasm was not associated with the elevated aGG. Admission GG correlated with admission serum glucose (r = 0.94, p < 0.01), lactate (r = 0.41, p < 0.01), procalcitonin (r = 0.38, p < 0.01), and Hunt and Hess score (r = 0.51, p < 0.01), but not with HbA1c (r = 0.02, p = 0.82). Compared to admission glucose, aGG had a statistically significantly improved accuracy in predicting inpatient mortality (AUC mean ± SEM: 0.77 ± 0.05 vs. 0.72 ± 0.06, p = 0.03) and trended toward statistically improved accuracy in predicting poor composite outcome (AUC: 0.69 ± 0.05 vs. 0.66 ± 0.05, p = 0.07). When controlling for aSAH severity, aGG was not independently associated with delayed cerebral ischemia, poor composite outcome, and in-hospital mortality.Conclusion: Admission GG was not independently associated with in-hospital mortality or poor outcome in a population of aSAH. An aGG ≥30 mg/dL was common in our population, and further study is needed to fully understand the clinical importance of this biomarker.Philip Y. SunRoy A. PobletePeggy L. NguyenSebina F. BulicMay A. Kim-TenserJonathan MarehbianSteven Y. CenBenjamin A. EmanuelFrontiers Media S.A.articleaneurysmal subarachnoid hemorrhagehyperglycemiaglycemic gapoutcomesmortalityNeurology. Diseases of the nervous systemRC346-429ENFrontiers in Neurology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	aneurysmal subarachnoid hemorrhage hyperglycemia glycemic gap outcomes mortality Neurology. Diseases of the nervous system RC346-429
spellingShingle	aneurysmal subarachnoid hemorrhage hyperglycemia glycemic gap outcomes mortality Neurology. Diseases of the nervous system RC346-429 Philip Y. Sun Roy A. Poblete Peggy L. Nguyen Sebina F. Bulic May A. Kim-Tenser Jonathan Marehbian Steven Y. Cen Benjamin A. Emanuel Association Between Glycemic Gap and In-hospital Outcomes in Aneurysmal Subarachnoid Hemorrhage
description	Introduction: Glycemic gap (GG), as determined by the difference between glucose and the hemoglobin A1c (HbA1c)-derived estimated average glucose (eAG), is associated with poor outcomes in various clinical settings. There is a paucity of data describing GG and outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Our main objectives were to evaluate the association of admission glycemic gap (aGG) with in-hospital mortality and with poor composite outcome and to compare aGG's predictive value to admission serum glucose. Secondary outcomes were the associations between aGG and neurologic complications including vasospasm and delayed cerebral ischemia following aSAH.Methods: We retrospectively reviewed 119 adult patients with aSAH admitted to a single tertiary care neuroscience ICU. Spearman method was used for correlation for non-normality of data. Area under the curve (AUC) for Receiver Operating Characteristic (ROC) curve was used to estimate prediction accuracy of aGG and admission glucose on outcome measures. Multivariable analyses were conducted to assess the value of aGG in predicting in-hospital poor composite outcome and death.Results: Elevated aGG at or above 30 mg/dL was identified in 79 (66.4%) of patients. Vasospasm was not associated with the elevated aGG. Admission GG correlated with admission serum glucose (r = 0.94, p < 0.01), lactate (r = 0.41, p < 0.01), procalcitonin (r = 0.38, p < 0.01), and Hunt and Hess score (r = 0.51, p < 0.01), but not with HbA1c (r = 0.02, p = 0.82). Compared to admission glucose, aGG had a statistically significantly improved accuracy in predicting inpatient mortality (AUC mean ± SEM: 0.77 ± 0.05 vs. 0.72 ± 0.06, p = 0.03) and trended toward statistically improved accuracy in predicting poor composite outcome (AUC: 0.69 ± 0.05 vs. 0.66 ± 0.05, p = 0.07). When controlling for aSAH severity, aGG was not independently associated with delayed cerebral ischemia, poor composite outcome, and in-hospital mortality.Conclusion: Admission GG was not independently associated with in-hospital mortality or poor outcome in a population of aSAH. An aGG ≥30 mg/dL was common in our population, and further study is needed to fully understand the clinical importance of this biomarker.
format	article
author	Philip Y. Sun Roy A. Poblete Peggy L. Nguyen Sebina F. Bulic May A. Kim-Tenser Jonathan Marehbian Steven Y. Cen Benjamin A. Emanuel
author_facet	Philip Y. Sun Roy A. Poblete Peggy L. Nguyen Sebina F. Bulic May A. Kim-Tenser Jonathan Marehbian Steven Y. Cen Benjamin A. Emanuel
author_sort	Philip Y. Sun
title	Association Between Glycemic Gap and In-hospital Outcomes in Aneurysmal Subarachnoid Hemorrhage
title_short	Association Between Glycemic Gap and In-hospital Outcomes in Aneurysmal Subarachnoid Hemorrhage
title_full	Association Between Glycemic Gap and In-hospital Outcomes in Aneurysmal Subarachnoid Hemorrhage
title_fullStr	Association Between Glycemic Gap and In-hospital Outcomes in Aneurysmal Subarachnoid Hemorrhage
title_full_unstemmed	Association Between Glycemic Gap and In-hospital Outcomes in Aneurysmal Subarachnoid Hemorrhage
title_sort	association between glycemic gap and in-hospital outcomes in aneurysmal subarachnoid hemorrhage
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/ffeed506c4ee4ce1b86625f0ad4e98bc
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Association Between Glycemic Gap and In-hospital Outcomes in Aneurysmal Subarachnoid Hemorrhage

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