Prognostic Value of Adding Admission Blood Glucose to the GRACE Score: Systematic Review and Meta-Analysis

Abstract

Background:

Hyperglycemia at admission is associated with higher morbidity and mortality in patients with Acute Coronary Syndrome (ACS). However, it remains unclear whether the inclusion of admission glycemia improves risk prediction atop established prognostic models.

Objectives:

To evaluate the incremental prognostic value of admission glycemia when added to the Global Registry of Acute Coronary Events (GRACE) risk score.

Methods:

A systematic search of PubMed, Embase, and ScienceDirect was conducted to identify cohort studies comparing GRACE with models that included admission blood glucose in patients with ACS. Random-effects meta-analyses were performed to compare mean differences (MDs) in predictive discrimination between models, measured by the area under the receiver operating characteristic curve (AUROC). Statistical significance was defined as p <0.05. Heterogeneity was assessed using Cochran's Q and Higgins–Thompson's I² statistics. In accordance with Cochrane recommendations, the risk of bias in individual studies was evaluated using the Quality in Prognosis Studies (QUIPS) tool.

Results:

In a pooled analysis of eight independent comparisons from seven studies encompassing 6,536 patients, a statistically significant difference was observed between GRACE and GRACE-glucose models (MD, 0.03; 95% CI, 0.00–0.05; p = 0.027; I² = 0%). Leave-one-out sensitivity analyses confirmed statistically significant differences in AUROCs. Meta-regression analyses did not demonstrate any modification in predictive discrimination based on overall risk of bias, mortality follow-up, or baseline prevalence of STEMI. Underreporting of calibration measures precluded a definitive assessment of predictive calibration.

Conclusions:

In this systematic review and meta-analysis, the inclusion of admission blood glucose enhanced prognostic value beyond the GRACE score alone.