Wnuk Marcin, Popiela Tadeusz, Drabik Leszek, Brzegowy Pawel, Lasocha Bartosz, Wloch-Kopec Dorota, Pulyk Roman, Jagiella Jeremiasz, Wiacek Marcin, Kaczorowski Rafal, Bartosik-Psujek Halina, Slowik Agnieszka
Jagiellonian University Medical College, Department of Neurology, Krakow, Poland; University Hospital in Krakow, Poland.
University Hospital in Krakow, Poland; Jagiellonian University Medical College, Department of Radiology, Krakow, Poland.
J Stroke Cerebrovasc Dis. 2020 May;29(5):104774. doi: 10.1016/j.jstrokecerebrovasdis.2020.104774. Epub 2020 Mar 19.
Little is known about the prognostic role of fasting glucose after mechanical thrombectomy (MT).
We investigated whether fasting glucose on the next day after MT was associated with long-term outcome in acute ischemic stroke patients according to diabetes.
We retrospectively analyzed 181 consecutive patients with acute anterior circulation ischemic stroke who underwent MT in 2 comprehensive stroke centers in Poland. Glucose levels were evaluated on admission and on the next day after MT. Fasting hyperglycemia (FHG) was defined as the glucose level above 5.5 mmol/L. Unfavorable outcome was defined as modified Rankin scale (mRS) of 3-6 at day 90 from stroke onset.
Patients with FHG had higher mRS at 3-month follow-up compared with those without FHG (3.71 ± 2.56 versus 1.87 ± 2.22, P < .001). In the subgroup analyses, FHG was associated with poor neurological outcome in the group without diabetes (3.74 ± 2.52 versus 1.81 ± 3.74, P < .001) but not with diabetes (3.64 ± 2.67 versus 2.30 ± 3.74, P= .11). Patients without diabetes who had FHG were older, had higher glucose on admission, higher prevalence of atrial fibrillation, cardioembolic stroke etiology and bleeding brain complications compared with the group with normal fasting glucose. After adjustment for potential confounders, fasting glucose (odds ratio [OR] 1.46; 95% CI 1.19-1.79, P < .001), age (OR 1.06; 95% CI 1.02-1.10, P = .001), successful reperfusion (OR 0.09; 95% CI 0.04-0.22, P < .001) and baseline NIHSS score (OR 1.18; 95% CI 1.08-1.29, P < .001) were predictors of mRS 3-6 at 3-month follow-up in the whole group. In the subgroup without diabetes, fasting glucose (OR 1.57; 95% CI 1.17-2.11, P = .002), age (OR 1.05; 95% CI 1.01-1.08, P = .008), successful reperfusion (OR 0.11; 95% CI 0.04-0.30, P < .001) and baseline NIHSS score (OR 1.14; 95% CI 1.04-1.26, P = .011) were independent predictors of unfavorable 3-month outcome.
Fasting glucose on the next day after MT in patients with acute ischemic stroke is an independent risk factor for worse 3-month outcome.
关于机械取栓（MT）后空腹血糖的预后作用，人们了解甚少。
我们研究了MT术后次日的空腹血糖是否根据糖尿病情况与急性缺血性卒中患者的长期预后相关。
我们回顾性分析了在波兰2个综合卒中中心接受MT的181例连续性急性前循环缺血性卒中患者。在入院时和MT术后次日评估血糖水平。空腹血糖过高（FHG）定义为血糖水平高于5.5 mmol/L。不良预后定义为卒中发病后90天时改良Rankin量表（mRS）评分为3 - 6分。
与无FHG的患者相比，有FHG的患者在3个月随访时mRS评分更高（3.71±2.56对1.87±2.22，P <.001）。在亚组分析中，FHG与无糖尿病组的不良神经功能结局相关（3.74±2.52对1.81±3.74，P <.001），但与糖尿病组无关（3.64±2.67对2.30±3.74，P =.11）。与空腹血糖正常组相比，无糖尿病且有FHG的患者年龄更大，入院时血糖更高，房颤患病率更高，心源性栓塞性卒中病因及脑内出血并发症更多。在对潜在混杂因素进行校正后，空腹血糖（比值比[OR] 1.46；95%置信区间1.19 - 1.79，P <.001）、年龄（OR 1.06；95%置信区间1.02 - 1.10，P =.001）、成功再灌注（OR 0.09；95%置信区间0.04 - 0.22，P <.001）和基线美国国立卫生研究院卒中量表（NIHSS）评分（OR 1.18；95%置信区间1.08 - 1.29，P <.001）是全组3个月随访时mRS 3 - 6分的预测因素。在无糖尿病亚组中，空腹血糖（OR 1.57；95%置信区间1.17 - 2.11，P =.002）、年龄（OR 1.05；95%置信区间1.01 - 1.08，P =.008）、成功再灌注（OR 0.11；95%置信区间0.04 - 0.30，P <.001）和基线NIHSS评分（OR 1.14；95%置信区间1.04 - 1.26，P =.011）是3个月不良结局的独立预测因素。
急性缺血性卒中患者MT术后次日的空腹血糖是3个月预后较差的独立危险因素。
