McCall Stephen J, Alanazi Turkiah A, Clark Allan B, Musgrave Stanley D, Bettencourt-Silva Joao H, Bachmann Max O, Metcalf Anthony K, Bowles Kristian M, Mamas Mamas A, Potter John F, Myint Phyo K
1 Ageing Clinical and Experimental Research Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK.
2 Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Diab Vasc Dis Res. 2018 Mar;15(2):114-121. doi: 10.1177/1479164117743034. Epub 2017 Nov 29.
We assessed the association between admission blood glucose levels and acute stroke mortality and examined whether there was any incremental value of adding glucose status to the validated acute stroke mortality predictor - the SOAR (stroke subtype, Oxford Community Stroke Project classification, age, and pre-stroke modified Rankin) score.
Data from Norfolk and Norwich University Hospital stroke and Transient Ischaemic Attack register (2003-2013) and Anglia Stroke Clinical Network Evaluation Study (2009-2012) were analysed. Multivariable logistic regression analysis assessed the association between admission blood glucose levels with inpatient and 7-day mortality. The prognostic ability of the SOAR score was then compared with the SOAR with glucose score.
A total of 5575 acute stroke patients (ischaemic stroke: 89.2%) with mean age (standard deviation) of 76.97 ( ± 11.88 ) years were included. Both borderline hyperglycaemia (7.9-11.0 mmol/L) and hyperglycaemia (>11.0 mmol/L) when compared to normoglycaemia (4.0-7.8 mmol/L) were associated with both 7-day and inpatient mortality after controlling for sex, age, Oxford Community Stroke Project classification and pre-stroke modified Rankin score. Both the SOAR stroke score and SOAR-G score were good predictors of inpatient stroke mortality [area under the curve: 0.82 (95% confidence interval: 0.81-0.84) and 0.83 (95% confidence interval: 0.81-0.84)], respectively. These scores were also good at predicting outcomes in both patients with and without diabetes.
High blood glucose levels at admission were associated with worse acute stroke mortality outcomes. The constituents of the SOAR stroke score were good at predicting mortality after stroke.
我们评估了入院血糖水平与急性卒中死亡率之间的关联，并研究了在经过验证的急性卒中死亡率预测指标——SOAR（卒中亚型、牛津社区卒中项目分类、年龄和卒中前改良Rankin量表）评分中加入血糖状态是否具有额外价值。
分析了诺福克和诺维奇大学医院卒中与短暂性脑缺血发作登记处（2003 - 2013年）以及东安格利亚卒中临床网络评估研究（2009 - 2012年）的数据。多变量逻辑回归分析评估了入院血糖水平与住院患者及7天死亡率之间的关联。然后将SOAR评分的预后能力与加入血糖因素后的SOAR评分进行比较。
共纳入5575例急性卒中患者（缺血性卒中：89.2%），平均年龄（标准差）为76.97（±11.88）岁。在控制了性别、年龄、牛津社区卒中项目分类和卒中前改良Rankin量表评分后，与正常血糖水平（4.0 - 7.8 mmol/L）相比，临界高血糖（7.9 - 11.0 mmol/L）和高血糖（>11.0 mmol/L）均与7天和住院患者死亡率相关。SOAR卒中评分和SOAR - G评分均是住院卒中死亡率的良好预测指标[曲线下面积分别为：0.82（95%置信区间：0.81 - 0.84）和0.83（95%置信区间：0.81 - 0.84）]。这些评分在预测糖尿病患者和非糖尿病患者的预后方面也表现良好。
入院时高血糖水平与更差的急性卒中死亡率结局相关。SOAR卒中评分的各个组成部分在预测卒中后死亡率方面表现良好。
