Stress hyperglycemia is associated with longer ICU length of stay after endoscopic intracerebral hemorrhage evacuation

• Published in: Journal of stroke and cerebrovascular diseases 2024-10, Vol.33 (10), p.107911, Article 107911
• Main Authors: Vasa, Devarshi, Rossitto, Christina P., Ezzat, Bahie, Bazil, Maximilian, Schuldt, Braxton, Johnson, Brian, Ali, Muhammad, Mocco, J., Kellner, Christopher P.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biomarkers - blood; Blood Glucose - metabolism; Cerebral Hemorrhage - blood; Cerebral Hemorrhage - diagnosis; Cerebral Hemorrhage - surgery; Disability Evaluation; Female; Glucose-to-HbA1c ratio; Glycated Hemoglobin - metabolism; Humans; Hyperglycemia - blood; Hyperglycemia - diagnosis; Intensive Care Units; Intracerebral hemorrhage; Length of Stay; Male; Middle Aged; Minimally invasive surgery; Neurosurgical Procedures - adverse effects; Postoperative outcomes; Predictive Value of Tests; Retrospective Studies; Risk Assessment; Risk Factors; Stress hyperglycemia; Stroke; Time Factors; Treatment Outcome
• ISSN: 1052-3057; 1532-8511; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2024.107911

Stress hyperglycemia has been linked to poor outcomes in intracerebral hemorrhage (ICH). Recent studies using the ratio of blood glucose to glycated hemoglobin (HbA1c) as a marker for stress hyperglycemia have demonstrated greater discriminative power in predicting poor outcomes for stroke inpatients compared to blood glucose alone. Therefore, we aimed to investigate whether the preoperative glucose-to-HbA1c ratio is a predictor of postoperative outcomes in patients who have undergone minimally invasive ICH evacuation. Retrospective chart review was performed on ICH patients treated with minimally invasive surgery (MIS) in a single health system from 2015 to 2022. Stress hyperglycemia was defined as preoperative glucose-to-HbA1c ratio > calculated-median. Postoperative outcomes including modified Rankin Score (mRS) and length of stay (LOS) were collected. Univariate analyses were conducted to determine associations. Variables with p 1.23). Patients with stress hyperglycemia were more likely to have a history of diabetes (43 % vs. 27 %, p=0.034), IVH (54 % vs. 33 %, p=0.007), higher preoperative hematoma volumes (46.8 ml vs. 38.6 mL, p=0.02), higher postoperative hematoma volumes (6 ml vs. 2.9 mL, p=0.008), smaller evacuation percentages (86.7 % vs. 92.7 %, p=0.048), longer procedure lengths (2.78 hrs vs. 2.23 hrs, p=0.015), and prolonged ICU LOS (9.44 days vs. 5.68 days, p=0.003). In a multivariate analysis, stress hyperglycemia remained predictive of prolonged ICU LOS (OR=2.44; p=0.026) when controlling for initial NIHSS, IVH, time to evacuation, procedure time, and diabetes. Stress hyperglycemia was strongly associated with prolonged ICU LOS after MIS for ICH. Understanding factors associated with LOS may provide predictive value for a patient's hospital course after minimally invasive ICH evacuation and further guide clinician expectations of recovery.