Correlation between blood glucose variability and the risk of death within 3 months in patients with severe acute stroke

Objective To investigate the correlation between blood glucose variability and the risk of death within 3 months in patients with severe acute stroke. Methods The clinical data of 176 patients with acute severe acute stroke admitted to the Neurology Intensive Care Unit, the Affiliated Hospital of Hebei University were analyzed retrospectively. They were divided into a survival group and a death group according to the outcomes within 3 months. The baseline National Institutes of Health Stroke Scale(NIHSS)score, Acute Physiology and Chronic Health Evaluation(APACHE)Ⅱ, mean blood glucose, blood glucose standard deviation, mean amplitude of glycemic excursion, mean coefficient of variation of blood glucose, and other clinical data were compared between both groups. Multivariate logistic regression analysis was used to determine the independent predictors of death within 3 months. Results A total of 176 patients with severe acute stroke were included, 124(70.4%)with ischemic stroke, 52(29.6%)with intracerebral hemorrhage, and 27(15.3%)died within 3 months. The baseline NIHSS scores(22.5±2.3 vs. 17.1±2.7; t=8.974, P<0.001), APACHE Ⅱ scores(17.5±5.1 vs. 6.8±7.1; t=13.136, P<0.001), blood glucose standard deviation(3.6±2.2 mmol/L vs. 1.4±1.1 mmol/L; t=9.246, P<0.001), mean amplitude of glycemic excursion(6.3±3.5 mmol/L vs. 3.8±2.1 mmol/L; t=5.989, P<0.001), and mean coefficient of variation of blood glucose(43.3%±13.1% vs. 22.8%±11.3%; t=8.593, P<0.001)in the death group were significantly higher than those in the survival group, however, there was no significant difference in the mean blood glucose(13.5±1.7 mmol/L vs. 12.6±1.5 mmol/L; t=0.990, P=0.323). Multivariate logistic regression analysis showed that the baseline APACHEⅡscores(odds ratio[OR]2.911, 95% confidence interval[CI]1.962-4.560; P<0.001), NIHSS scores(OR 12.436, 95%CI 5.071-30.495; P<0.001), blood glucose standard deviation(OR 4.302, 95%CI 1.855-9.973; P=0.001), mean amplitude of glycemic excursion(OR 7.231, 95%CI 1.585-32.992; P=0.011), and mean coefficient of variation of blood glucose(OR 3.408, 95%CI 1.363-8.522; P=0.009)were the independent predictors of death within 3 months in patients with severe acute stroke. Conclusions The blood glucose variability is an independent predictor of death within 3 months in patients with severe acute stroke. The great range of glycemic excursion indicates poor outcome. Its baseline predictive value is almost the same with the APACHE Ⅱ score. In contrast, the mean blood glucose level do not have significant correlation with the outcomes of patients. Key words: Stroke; Brain Ischemia; Cerebral Hemorrhage; Blood Glucose; Hyperglycemia; Critical Illness; Prognosis