Blood glucose variability, NIHSS score, APACHE II score, and prognosis in patients with acute and severe cerebrovascular disease / 中国基层医药

ABSTRACT

Objective:To investigate blood glucose variability, National Institutes of Health Stroke Scale (NIHSS) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score and prognosis in patients with acute and severe cerebrovascular disease, providing a reference for clinical treatment of this disease.Methods:The clinical data of 76 patients with acute and severe cerebrovascular disease who received treatment in Xixi Hospital of Hangzhou between January 2014 and December 2019 were retrospectively analyzed. These patients were divided into a survival group ( n = 51) and a death group ( n = 25) according to the prognosis 28 days after admission. Baseline data, baseline NIHSS score, APACHE II score, standard deviation of blood glucose, mean blood glucose, mean amplitude of glycemic excursions, and blood glucose variability rate were compared between the survival and death groups. The effects of these parameters on the prognosis of acute and severe cerebrovascular disease were analyzed. Results:There were no significant differences in gender, age, history of diabetes, type of disease, and length of hospital stay between the two groups ( χ2 = 1.674, t = 1.048, χ2 = 3.833, 0.263, t = 0.832, all P > 0.05). The proportion of patients with a history of hypertension in the death group was significantly higher than that in the survival group [15.69% (8/51) vs. 52.00% (13/25), χ2 = 11.063, P < 0.05]. There was no significant difference in mean blood glucose between the two groups ( t = 0.118, P > 0.05). The baseline NIHSS score, APACHE II score, standard deviation of blood glucose, mean amplitude of glycemic excursions and blood glucose variability rate in the death group were (24.41 ± 4.14) points, (25.00 ± 6.97) points, (2.72 ± 0.91) mmol/L, (6.27 ± 2.01) mmol/L, (34.83 ± 5.61) %,which were significantly higher than those in the survival group [(17.22 ± 3.63) points, (19.21 ± 5.36) points, (1.69 ± 0.70) mmol/L, (3.72 ± 1.68) mmol/L, (19.54 ± 3.22) %, t = 7.744, 3.999, 5.448, 5.823, 15.095, all P < 0.05]. The proportion of patients with blood glucose variability rate < 20% in the death group was significantly lower than that in the survival group [16.00% (4/25) vs. 74.51% (38/51), χ2= 23.230, P < 0.05]. The proportion of patients with blood glucose variability rate > 30% in the death group was significantly higher than that in the survival group [60.00% (15/25) vs. 13.73% (7/51), χ2 = 17.466, P < 0.05). Logistic regression analysis revealed that baseline NIHSS score, APACHE II score, standard deviation of blood glucose, mean amplitude of glycemic excursions, and blood glucose variability rate were the independent risk factors of death of cerebrovascular disease patients (all P < 0.05). Conclusion:In patients with acute and severe cerebrovascular disease, an obvious blood glucose fluctuation, high baseline NIHSS score, and high APACHE II score help to assess the prognosis of acute and severe cerebrovascular disease and determine the risk of death.