Flevoziekenhuis, Almere, the Netherland.
Isala, Zwolle, the Netherlands.
J Stroke Cerebrovasc Dis. 2020 Jun;29(6):104815. doi: 10.1016/j.jstrokecerebrovasdis.2020.104815. Epub 2020 Apr 14.
Impaired glucose tolerance (IGT) in patients with ischemic stroke can return to normal, reflecting an acute stress response, or persist. Persistent IGT is associated with an increased risk of recurrent stroke, other cardiovascular diseases and unfavorable outcome after stroke. We aim to validate our previously developed model to identify patients at risk of persistent IGT in an independent data set, and, if necessary, update the model.
The validation data set consisted of 239 nondiabetic patients with a minor ischemic stroke or TIA and IGT in the acute phase (2-hour post-load glucose levels between 7.8 and 11.0 mmol/l). The outcome was persistent versus normalized IGT, based on repeated oral glucose tolerance test after a median of 46 days. The discriminative ability of the original model was assessed with the area under the ROC curve (AUC). The updated model was internally validated with bootstrap resampling and cross-validated in the development population of the original model.
One-hundred eighteen of 239 (49%) patients had persistent IGT. The original model, with the predictors age, current smoking, statin use, triglyceride, hypertension, history of cardiovascular diseases, body mass index (BMI), fasting plasma glucose performed poorly (AUC .60). The newly developed model included only BMI, hypertension, statin use, atrial fibrillation, 2-hour post-load glucose levels, HbA1c, large artery atherosclerosis, and predicted persistent IGT more accurately (internally validated AUC 0.66, externally validated AUC .71).
This prediction model with simple clinical variables can be used to predict persistent IGT in patients with IGT directly after minor stroke or TIA, and may be useful to optimize secondary prevention by early identification of patients with disturbed glucose metabolism.
缺血性脑卒中患者的糖耐量受损（IGT）可恢复正常，反映出急性应激反应，或持续存在。持续性 IGT 与复发性脑卒中、其他心血管疾病以及脑卒中后不良结局的风险增加相关。我们旨在验证我们之前开发的模型，以在独立数据集识别出持续性 IGT 风险患者，并在必要时更新模型。
验证数据集包含 239 例非糖尿病的小卒中或 TIA 患者和急性 IGT（负荷后 2 小时血糖水平在 7.8 至 11.0mmol/L 之间）。根据中位 46 天后重复口服葡萄糖耐量试验的结果，将结局定义为持续性 IGT 与正常糖耐量。原始模型的判别能力通过 ROC 曲线下面积（AUC）进行评估。使用 Bootstrap 重采样对更新后的模型进行内部验证，并在原始模型的开发人群中进行交叉验证。
239 例患者中有 118 例（49%）存在持续性 IGT。原模型的预测指标包括年龄、当前吸烟、他汀类药物使用、甘油三酯、高血压、心血管疾病史、体重指数（BMI）、空腹血糖，其表现不佳（AUC.60）。新开发的模型仅包含 BMI、高血压、他汀类药物使用、心房颤动、负荷后 2 小时血糖水平、HbA1c、大动脉粥样硬化，更准确地预测了持续性 IGT（内部验证 AUC 0.66，外部验证 AUC.71）。
这个包含简单临床变量的预测模型可用于预测小卒中或 TIA 后即刻的 IGT 患者的持续性 IGT，通过早期识别葡萄糖代谢紊乱患者，可能有助于优化二级预防。
