Tziomalos Konstantinos, Dimitriou Panagiotis, Bouziana Stella D, Spanou Marianna, Kostaki Stavroula, Angelopoulou Stella-Maria, Papadopoulou Maria, Giampatzis Vasilios, Savopoulos Christos, Hatzitolios Apostolos I
First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
Metabolism. 2017 Feb;67:99-105. doi: 10.1016/j.metabol.2016.11.011. Epub 2016 Nov 25.
Stress hyperglycemia is frequent in patients with acute ischemic stroke. However, it is unclear whether stress hyperglycemia only reflects stroke severity or if it is directly associated with adverse outcome. We aimed to evaluate the prognostic significance of stress hyperglycemia in acute ischemic stroke.
We prospectively studied 790 consecutive patients who were admitted with acute ischemic stroke (41.0% males, age 79.4±6.8years). The severity of stroke was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). Stress hyperglycemia was defined as fasting serum glucose levels at the second day after admission ≥126mg/dl in patients without type 2 diabetes mellitus (T2DM). The outcome was assessed with adverse outcome rates at discharge (modified Rankin scale between 2 and 6) and with in-hospital mortality.
In the total study population, 8.6% had stress hyperglycemia. Patients with stress hyperglycemia had more severe stroke. Independent predictors of adverse outcome at discharge were age, prior ischemic stroke and NIHSS at admission whereas treatment with statins prior to stroke was associated with favorable outcome. When the NIHSS was removed from the multivariate model, independent predictors of adverse outcome were age, heart rate at admission, prior ischemic stroke, log-triglyceride (TG) levels and stress hyperglycemia, whereas treatment with statins prior to stroke was associated with favorable outcome. Independent predictors of in-hospital mortality were atrial fibrillation (AF), diastolic blood pressure (DBP), serum log-TG levels and NIHSS at admission. When the NIHSS was removed from the multivariate model, independent predictors of in-hospital mortality were age, AF, DBP, log-TG levels and stress hyperglycemia.
Stress hyperglycemia does not appear to be directly associated with the outcome of acute ischemic stroke. However, given that patients with stress hyperglycemia had higher prevalence of cardiovascular risk factors than patients with normoglycemia and that glucose tolerance was not evaluated, more studies are needed to validate our findings.
急性缺血性脑卒中患者常出现应激性高血糖。然而，应激性高血糖是仅反映卒中严重程度，还是与不良预后直接相关尚不清楚。我们旨在评估应激性高血糖在急性缺血性脑卒中中的预后意义。
我们对790例连续收治的急性缺血性脑卒中患者进行了前瞻性研究（男性占41.0%，年龄79.4±6.8岁）。入院时采用美国国立卫生研究院卒中量表（NIHSS）评估卒中严重程度。应激性高血糖定义为非2型糖尿病（T2DM）患者入院后第二天空腹血糖水平≥126mg/dl。出院时采用不良结局发生率（改良Rankin量表评分在2至6分之间）和院内死亡率评估结局。
在整个研究人群中，8.6%的患者有应激性高血糖。应激性高血糖患者的卒中更严重。出院时不良结局的独立预测因素为年龄、既往缺血性脑卒中史和入院时的NIHSS，而卒中前使用他汀类药物治疗与良好结局相关。当NIHSS从多变量模型中剔除后，不良结局的独立预测因素为年龄、入院时心率、既往缺血性脑卒中史、对数甘油三酯（TG）水平和应激性高血糖，而卒中前使用他汀类药物治疗与良好结局相关。院内死亡的独立预测因素为心房颤动（AF）、舒张压（DBP）、血清对数TG水平和入院时的NIHSS。当NIHSS从多变量模型中剔除后，院内死亡的独立预测因素为年龄、AF、DBP、对数TG水平和应激性高血糖。
应激性高血糖似乎与急性缺血性脑卒中的结局无直接关联。然而，鉴于应激性高血糖患者心血管危险因素的患病率高于血糖正常的患者，且未评估糖耐量，需要更多研究来验证我们的发现。
