Different indicators of stress-induced hyperglycemia and poor outcomes after spontaneous intracerebral hemorrhage

Background This study aimed to compare the predictive value of metrics unique to stress-induced hyperglycemia (SIH) with fasting blood on poor functional outcomes of spontaneous intracerebral hemorrhage (sICH). Methods This investigation included 528 patients from a multicenter, observational, prospective cohort study. Poor functional outcomes were defined as modified Rankin Scale(mRS) ≥ 3. Logistic regression analyses were used to assess the relationship between indicators of SIH, including fasting blood glucose (FBG), two definitions of the stress hyperglycemia ratio [SHR, the fast blood glucose concentration/estimated average glucose (SHR1) and the ratio of glucose to HbA1c(SHR2)], and glycemic gap (GG), and poor functional outcomes at 30-day, 90-day, and 1-year. Results Higher values of all these indicators for SIH (e.g., FBG, GG, SHR1, and SHR2) were independently related to poor outcomes at 30-day, 90-day, and 1-year in patients with sICH (p < 0.05 for all models). Compared with the area under the curve (AUC), all these indicators performed greater AUC in predicting poor prognosis at 1-year (FBG: AUC=0.710; GG: AUC=0.741; SHR1: AUC=0.743) than 30-day and 90-day. And SHR2 has the highest predictive value among these indicators (AUC=0.748). Finally, diabetes had no statistical effect on the correlation between these indicators and poor functional outcomes at 30-day, 90-day, and 1-year in subgroup analysis (p for interaction >0.05). Conclusions Patients with higher FBG, GG, SHR1, and SHR2 values were more likely to have a poor functional outcome. SHR2 has the highest predictive value for poor outcomes at 30-day, 90-day and 1-year.