Effect of stress-induced hyperglycemia after non-traumatic non-aneurysmal subarachnoid hemorrhage on clinical complications and functional outcomes

Association of the stress hyperglycemia ratio for all-cause and cardiovascular mortality in population with cardiovascular-kidney-metabolic syndrome stages 0-4: evidence from a large cohort study

BACKGROUND

The Cardiovascular-kidney-metabolic (CKM) syndrome is a health disorder caused by interactions between cardiovascular disease, kidney disease, and metabolism-related risk factors. The stress hyperglycemia ratio (SHR) has been shown to correlate with the prognosis of participants with diabetes mellitus, heart failure, and myocardial infarction. However, the predictive value of SHR in the CKM syndrome population is unclear and requires further exploration.

METHODS

This study analyzed 19,345 participants from the National Health and Nutrition Examination Survey (1999-2018). CKM syndrome was staged according to the American Heart Association (AHA) guidelines. SHR was calculated using fasting blood glucose (FBG) and glycated hemoglobin type A1c (HbA1c). Participants were grouped into four quartiles based on SHR. The primary and secondary outcomes were all-cause mortality and cardiovascular mortality, respectively. Kaplan-Meier survival curves and Cox proportional hazard regression models were used to evaluate the association between SHR and outcomes. Then, the potential nonlinear relationship was explored using restricted cubic spline (RCS) analysis. We also performed subgroup analyses to assess the effects of different variables.

RESULTS

A total of 2,736 all-cause deaths and 699 cardiovascular deaths were recorded during a median follow-up period of 115 months. Kaplan-Meier analysis revealed that participants in quartile 2 had the lowest risk for both all-cause and cardiovascular mortality (Log Rank P < 0.05). Multivariate Cox regression demonstrated the lowest all-cause mortality in the 2nd quartile (HR = 0.84, 95% CI = 0.73-0.97, P = 0.015) and the highest all-cause mortality in the 4th quartile (HR = 1.19, 95% CI = 1.03-1.37, P = 0.018), compared with the 1st quartile group of SHR. The RCS curve demonstrated a U-shape association of SHR with both all-cause and cardiovascular mortality, with the lowest points of 0.89 and 0.91, respectively.

CONCLUSIONS

SHR is strongly correlated with prognosis in the CKM syndrome population, with high or low SHR increasing the risk of death. This index shows great potential for predicting the risk of death in this population.

Stress hyperglycemia in acute pancreatitis: From mechanisms to prognostic implications

Acute pancreatitis (AP) is an inflammatory reaction of the pancreas. When the disease is severe, it is often accompanied by destruction of the pancreatic islets, resulting in dysfunction of the endocrine system of the pancreas. Stress hyperglycemia is a transient increase in glucose during a critical illness, and its possible mechanism is related to abnormal glucose metabolism and insulin resistance due to the increased release of counterregulatory hormones and cytokines, such as glucagon, cortisol, and catecholamines. Numerous studies have shown that stress hyperglycemia is strongly associated with morbidity, mortality, and increased risk of post-acute pancreatitis diabetes in AP patients. Therefore, stress hyperglycemia may be a significant independent risk factor for poor clinical outcomes and prognosis in patients with AP. This article reviews the clinical features, risk factors, and mechanisms of action of stress hyperglycemia in AP and its influence on adverse clinical outcomes and the prognosis of inpatients with AP. For AP patients with stress hyperglycemia, it is necessary to comprehensively consider their blood glucose levels, daily habits, and complications to develop an appropriate treatment plan for hyperglycemia. Limited evidence indicates that in the case of acute hyperglycemia in critically ill patients, especially during the first 3 days of hospitalization, insulin therapy should not be undertaken if the blood glucose level does not exceed 10 mmol/L. However, some important questions related to clinical practice remain to be answered. More clinical trials and studies are needed in the future to provide a sufficient basis for clinical practice.

Stress hyperglycemia ratio is associated with delayed cerebrovascular ischemia and poor prognosis in patients with aneurysmal subarachnoid hemorrhage undergoing neurointerventional therapy

OBJECTIVE

Previous research has established a correlation between hyperglycemia following aneurysmal subarachnoid hemorrhage (aSAH) and the onset of delayed cerebrovascular ischemia (DCI), and influencing patient prognosis. The objective of this study was to evaluate the potential association between stress hyperglycemia ratio (SHR) and both the occurrence of DCI and prognosis in patients with aSAH undergoing neurointervention.

METHODS

We retrospectively analyzed 214 patients with aSAH undergoing neurointervention. The outcomes evaluated were DCI and 90-days poor prognosis (Modified Rankin Scale, mRS >2). The association between SHR level and both DCI and prognosis was analyzed. Stress hyperglycemia was assessed using SHR, calculated as: SHR = admission fasting plasma glucose (FPG, mmol/L) / [1.59 * hemoglobin A1c (HbA1c%) - 2.59].

RESULTS

Among the 214 patients, 59 (27.6 %) experienced DCI, and 60 (28 %) had a poor prognosis. Following adjustments for confounding factors, SHR emerged as an independent risk factor of both DCI (p = 0.006) and poor prognosis (p = 0.020), individuals in the T3 tertile of SHR had a higher risk of DCI than those in the T1 tertile [odds ratio (OR) 2.68; 95 % CI (1.19-6.06); p = 0.018], and individuals in the T3 tertile of SHR had a higher risk of poor 90-day prognosis than those in the T1 tertile [OR 2.47; 95 % CI (1.08-5.63); p = 0.032].

CONCLUSION

SHR was found to be a significant and independent risk factor for DCI and 90-days poor prognosis in patients with aSAH who underwent neurointerventional therapy.

A superior tool for predicting sepsis in SAH patients: The nomogram outperforms SOFA score

OBJECTIVE

This study aimed to develop and validate a nomogram to predict the risk of sepsis in non-traumatic subarachnoid hemorrhage (SAH) patients using data from the MIMIC-IV database.

METHODS

A total of 803 SAH patients meeting the inclusion criteria were randomly divided into a training set (563 cases) and a validation set (240 cases). Independent prognostic factors were identified through forward stepwise logistic regression, and a nomogram was created based on these factors. The discriminative ability of the nomogram was assessed using the area under the receiver operating characteristic curve (AUC) and compared with the SOFA score. The model's consistency was evaluated using the C-index, and the improvement in performance over the SOFA score was calculated using integrated discrimination improvement (IDI) and net reclassification improvement (NRI).

RESULTS

Five independent predictive factors were identified through LASSO regression analysis: mechanical ventilation, hyperlipidemia, temperature, white blood cell count, and red blood cell count. The AUC of the nomogram in the training and validation sets were 0.854 and 0.824, respectively, both higher than the SOFA score. NRI and IDI results indicated that the nomogram outperformed the SOFA score in identifying sepsis risk. Calibration curves and the Hosmer-Lemeshow test demonstrated good calibration of the nomogram. Decision curve analysis showed that the nomogram had higher net benefit in clinical application.

CONCLUSION

The nomogram developed in this study performed excellently in predicting the risk of sepsis in SAH patients, surpassing the traditional SOFA scoring system, and has significant clinical application value.

Effect of cortisol and glycosylated-hemoglobin levels on mortality in intensive care unit

OBJECTIVES

To research the effects of blood cortisol and hemoglobinA1c (HBA1C) levels on mortality in patients admitted to the intensive care unit (ICU) and whether these factors could be used as reliable indicators for mortality risk assessment in these patients.

METHODS

After receiving approval from the ethics committee, 79 patients admitted to ICU were included in the study. From patient files, we collected data on demographics (age, gender), presence of diabetes mellitus, and levels of cortisol, HbA1C, glucose, and lactate measured during hospitalization, along with acute physiology and chronic health evaluation (APACHE) II scores calculated within the first 24 hours. In our study, we planned to investigate the relationship between patients' cortisol and HbA1C levels and mortality.

RESULTS

A total of 79 patients were included in the study. The mortality rate of the patients included in the study was 65.8%. In the model established with all variables, only cortisol level (p=0.017) and APACHE II score (p=0.005) were defined to affect mortality.

CONCLUSION

Cortisol levels at the time of admission to the ICU were found to affect mortality and can be considered a predictive factor, while HBA1C levels showed no such effect. Our findings indicate that neither cortisol nor HBA1C levels had an impact on the duration of mechanical ventilation or length of stay in the ICU.

A predictive model using risk factor categories for hospital-acquired pneumonia in patients with aneurysmal subarachnoid hemorrhage

Objectives

To identify risk factors for hospital-acquired pneumonia (HAP) in patients with aneurysmal subarachnoid hemorrhage (aSAH) and establish a predictive model to aid evaluation.

Methods

The cohorts of 253 aSAH patients were divided into the HAP group (n = 64) and the non-HAP group (n = 189). Univariate and multivariate logistic regression were performed to identify risk factors. A logistic model (Model-Logit) was established based on the independent risk factors. We used risk factor categories to develop a model (Model-Cat). Receiver operating characteristic curves were generated to determine the cutoff values. Areas under the curves (AUCs) were calculated to assess the accuracy of models and single factors. The Delong test was performed to compare the AUCs.

Results

The multivariate logistic analysis showed that the age [p = 0.012, odds ratio (OR) = 1.059, confidence interval (CI) = 1.013-1.107], blood glucose (BG; >7.22 mmol/L; p = 0.011, OR = 2.781, CI = 1.263-6.119), red blood distribution width standard deviation (RDW-SD; p = 0.024, OR = 1.118, CI = 1.015-1.231), and Glasgow coma scale (GCS; p < 0.001, OR = 0.710, CI = 0.633-0.798) were independent risk factors. The Model-Logit was as follows: Logit(P) = -5.467 + 0.057 * Age + 1.023 * BG (>7.22 mmol/L, yes = 1, no = 0) + 0.111 * RDW-SD-0.342 * GCS. The AUCs values of the Model-Logit, GCS, age, BG (>7.22 mmol/L), and RDW-SD were 0.865, 0.819, 0.634, 0.698, and 0.625, respectively. For clinical use, the Model-Cat was established. In the Model-Cat, the AUCs for GCS, age, BG, and RDW-SD were 0.850, 0.760, 0.700, 0.641, and 0.564, respectively. The AUCs of the Model-Logit were insignificantly higher than the Model-Cat (Delong test, p = 0.157). The total points from -3 to 4 and 5 to 14 were classified as low- and high-risk levels, respectively.

Conclusions

Age, BG (> 7.22 mmol/L), GCS, and RDW-SD were independent risk factors for HAP in aSAH patients. The Model-Cat was convenient for practical evaluation. The aSAH patients with total points from 5 to 14 had a high risk for HAP, suggesting the need for more attention during treatment.

Low serum magnesium is associated with poor functional outcome in acute ischemic stroke or transient ischemic attack patients

AIM

The association between magnesium and outcomes after stroke is uncertain. We aimed to investigate the association of serum magnesium with all-cause mortality and poor functional outcome.

METHODS

We included patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) from the China National Stroke Registry III. We used Cox proportional hazards model for all-cause mortality and logistic regression model for poor functional outcome (modified Rankin Scale [mRS] 2-6/3-6) to examine the relationships.

RESULTS

Among the 6483 patients, the median (interquartile range) magnesium was 0.87 (0.80-0.93) mmol/L. Patients in the first quartile had a higher risk of mRS score 3-6/2-6 at 3 months (adjusted odds ratio [OR]: 1.30; 95% confidence interval [CI]: 1.02, 1.64; adjusted OR: 1.29; 95% CI: 1.04-1.59) compared with those in the fourth quartile. Similar results were found for mRS score 26 at 1 year. The age- and sex-adjusted hazard ratio (HR) with 95% CI in first quartile magnesium was 1.40 (1.02-1.93) for all-cause mortality within 1 year, but became insignificant (HR: 1.03; 95% CI: 0.71-1.50) after adjusting for potential variables.

CONCLUSIONS

Low serum magnesium was associated with a high risk of poor functional outcome in patients with AIS or TIA.

Exploration of Risk Factors for Poor Prognosis of Non-Traumatic Non-Aneurysmal Subarachnoid Hemorrhage

Background: Subarachnoid hemorrhage (SAH) is a devastating neurological disease associated with high rates of mortality and disability. Aneurysms are the main cause of non-traumatic subarachnoid hemorrhages. However, non-traumatic non-aneurysmal subarachnoid hemorrhage (naSAH), another clinical type of SAH, has been poorly studied for its prognosis and risk factors. Method and result: We collected demographic and clinical variables for 126 naSAH and 89 aneurysmal subarachnoid hemorrhage (aSAH) patients, including age and gender; hospitalization days; hematological indicators; clinical score scales; past medical history; and personal history. We found that the monocytes in naSAH (0.50 ± 0.26) patients were lower than in aSAH patients (0.60 ± 0.27). The prevalence of diabetes in naSAH (30.2%) patients was higher than in aSAH (14.5%) patients. The naSAH patients were divided into good and poor outcome groups based on the modified Rankin Scale at the 90th day (90-day mRS) after discharge. A univariate analysis showed that there were significant differences in age, white blood cell count (WBC), monocyte count, D-dipolymer, neuron-specific enolase (NSE), random blood glucose (RBG), aspartate transaminase (AST), urea and free triiodothyronine (FT3) between the two groups. A logistic regression showed that aging and high level NSE were independent risk factors for a poor outcome. The predictive ability of age (area under curve (AUC) = 0.71) and NSE (AUC = 0.68) were analyzed by a receiver operating characteristic (ROC) curve. The results of the logistic regression suggested that age, D-dipolymer, NSE, RBG, urea and FT3 distinguished and predicted the prognosis of naSAH. The discriminant analysis of the above variables revealed that the discriminant accuracy was 80.20%. Conclusions: Compared with aSAHs, naSAHs are more likely to occur in patients with diabetes, and the level of monocytes is lower. Moreover, the prognosis of elderly patients with an naSAH is relatively poor, and the level of NSE in the course of the disease also reflects the prognosis. Multivariate comprehensive analysis is helpful to judge the prognosis of patients at a small cost.