Abstract WP344: Lower Hemoglobin A1c is Associated With Higher In-Hospital Mortality in Intracerebral Hemorrhage

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Introduction: Relationship of prior glycemic status to outcomes in intracerebral hemorrhage (ICH) is not established.Hypothesis: Higher hemoglobin (Hb) A1c is associated with worse outcomes in ICH.Methods: Data harvested from GWTG-Stroke registry on patients with ICH between April 1, 2003 and September 30, 2015. Four ordinal groups made based on HbA1c values of <5.7%, 5.7-6.4%, 6.5-8.0% and >8.0%. Outcomes analyzed overall and separately for patients with or without history of diabetes using unadjusted and adjusted multivariable regression models.Results: Among 75,455 patients with ICH from 1,336 sites, the prevalence of diabetes was 36.2% and prediabetes (no prior history of diabetes and HbA1c between 5.7-6.4%) was 41.9%. An increasing trend in the median BMI values was noted across the groups, with worse HbA1c associated with higher BMI. Lower HbA1c was associated with higher in-hospital mortality (3947/25473 {15.5%} overall, 542/2852 {19.0%} in patients with history of diabetes, and 3405/22621{15.1%} in patients without history of diabetes) (Table), higher mRS, less chance of going home, and lower likelihood of having independent ambulatory status, also seen in unadjusted and adjusted outcomes (Figure). Only in patients with no prior diabetes history, both higher HbA1c and lower HBA1c were associated with higher in-hospital mortality.Conclusions: In this large cohort of ICH patients, contrary to our original hypothesis, lower HbA1c (rather than higher HbA1c) was associated with higher in-hospital mortality. Further studies are needed to better define the relationship between HbA1c and outcomes, for it may have important implications for care of ICH patients.

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