Global Health Neurology and Translational Neuroscience Laboratory, Sydney and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia.
South Western Sydney Clinical School, University of New South Wales, Australia.
Adv Clin Exp Med. 2022 Jun;31(6):583-596. doi: 10.17219/acem/146273.
Patients with diabetes are known to have worse outcomes after an acute ischemic stroke (AIS) relative to those without diabetes. However, the impact of diabetes on the outcomes after the reperfusion therapy is poorly understood.
This study investigated prognostic accuracy of diabetes and its association with clinical and safety outcomes in AIS patients receiving intravenous thrombolysis (IVT), endovascular thrombectomy (EVT), or both.
Studies were identified from PubMed, Embase and Cochrane databases, using the following inclusion criteria: (a) AIS patients receiving reperfusion therapy, (b) age ≥ 18 years, (c) hemispheric stroke, and (d) the availability of comparative data between diabetic and nondiabetic groups and relevant poststroke outcomes. Random effects modelling was used to study the association of diabetes with functional outcome at discharge and at 90 days, mortality at 90 days, recanalization status, and postreperfusion safety outcomes, including rates of symptomatic intracerebral hemorrhage (sICH) and hemorrhagic transformation (HT). Forest plots of odds ratios (ORs) were generated.
Of a total cohort of 82,764 patients who received reperfusion therapy, 16,877 had diabetes. Diabetes significantly increased the odds of poor functional outcome at discharge (OR 1.310; 95% confidence interval (95% CI): [1.091; 1.574]; p = 0.0037) and at 90 days (OR 1.487; 95% CI: [1.335; 1.656]; p < 0.00010), mortality at 90 days (OR 1.709; 95% CI: [1.633; 1.788]; p < 0.0001), sICH (OR 1.595; 95% CI: [1.301; 1.956]; p < 0.0001), and HT (OR 1.276; 95% CI: [1.055; 1.543]; p = 0.0118).
Our meta-analysis demonstrates that diabetes is significantly associated with poor functional outcome, increased mortality and poor postprocedural safety outcomes, including sICH and HT.
患有糖尿病的患者在经历急性缺血性中风（AIS）后，其预后比没有糖尿病的患者更差。然而，糖尿病对溶栓治疗后预后的影响尚不清楚。
本研究旨在探讨糖尿病对接受静脉溶栓（IVT）、血管内取栓（EVT）或联合治疗的 AIS 患者的预后准确性及其与临床和安全性结局的关系。
通过在 PubMed、Embase 和 Cochrane 数据库中进行检索，使用以下纳入标准确定研究：（a）接受再灌注治疗的 AIS 患者，（b）年龄≥18 岁，（c）半球性中风，（d）有糖尿病组和非糖尿病组的比较数据以及相关的卒中后结局。使用随机效应模型研究糖尿病与出院时和 90 天时的功能结局、90 天时的死亡率、再通状态以及再灌注后安全性结局（包括症状性颅内出血（sICH）和出血性转化（HT）的发生率）之间的关系。生成优势比（OR）的森林图。
在总共接受再灌注治疗的 82764 名患者中，有 16877 名患者患有糖尿病。糖尿病显著增加了出院时（OR 1.310；95%置信区间（95%CI）：[1.091；1.574]；p=0.0037）和 90 天时（OR 1.487；95%CI：[1.335；1.656]；p<0.00010）不良功能结局、90 天时的死亡率（OR 1.709；95%CI：[1.633；1.788]；p<0.0001）、sICH（OR 1.595；95%CI：[1.301；1.956]；p<0.0001）和 HT（OR 1.276；95%CI：[1.055；1.543]；p=0.0118）的风险。
我们的荟萃分析表明，糖尿病与不良的功能结局、死亡率增加以及包括 sICH 和 HT 在内的不良术后安全性结局显著相关。
