Filipov Alexandra, Fuchshuber Heike, Kraus Josephine, Ebert Anne D, Sandikci Vesile, Alonso Angelika
Department of Neurology, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
J Clin Med. 2022 Mar 15;11(6):1625. doi: 10.3390/jcm11061625.
Background: Patients with diabetes mellitus (DM) are known to show poor recovery after stroke. This specific burden might be due to acute and chronic hyperglycemic effects. Meanwhile, the underlying mechanisms are a cause of discussion, and the best measure to predict the outcome is unclear. Skin autofluorescence (SAF) reflects the in-patient load of so-called advanced glycation end products (AGEs) beyond HbA1c and represents a valid and quickly accessible marker of chronic hyperglycemia. We investigated the predictive potential of SAF in comparison to HbA1c and acute hyperglycemia on the functional outcome at 90 days after ischemic stroke in a cohort of patients with DM. Methods: We prospectively included 113 patients with DM type 2 hospitalized for acute ischemic stroke. SAF was measured on each patient’s forearm by a mobile AGE-Reader mu© in arbitrary units. HbA1c and the area under the curve (AUC) of the blood sugar profile after admission were assessed. Functional outcome was assessed via phone interview after 90 days. A poor outcome was defined as a deterioration to a modified Rankin Scale score ≥ 3. A good outcome was defined as a modified Rankin Scale score < 3 or as no deterioration from premorbid level. Results: Patients with a poor outcome presented with higher values of SAF (mean 3.38 (SD 0.55)) than patients with a good outcome (mean 3.13 (SD 0.61), p = 0.023), but did not differ in HbA1c and acute glycemia. In logistic regression analysis, age (p = 0.021, OR 1.24 [1.12−1.37]) and SAF (p = 0.021, OR 2.74 [1.16−6.46]) significantly predicted a poor outcome, whereas HbA1c and acute glycemia did not. Patients with a poor 90-day outcome and higher SAF experienced more infections (4.2% vs. 33.3% (p < 0.01)) and other various in-hospital complications (21.0% vs. 66.7% (p < 0.01)) than patients with a good outcome and lower SAF levels. Conclusions: SAF offers an insight into glycemic memory and appears to be a significant predictor of poor stroke outcomes in patients with DM exceeding HbA1c and acute glycemia. Measuring SAF could be useful to identify specifically vulnerable patients at high risk of complications and poor outcomes.
已知糖尿病（DM）患者中风后恢复较差。这种特殊负担可能归因于急性和慢性高血糖效应。同时，潜在机制仍存在争议，且预测预后的最佳指标尚不清楚。皮肤自发荧光（SAF）反映了糖化血红蛋白（HbA1c）之外所谓晚期糖基化终末产物（AGEs）的体内负荷，是慢性高血糖的有效且快速获取的标志物。我们在一组糖尿病患者中研究了SAF与HbA1c及急性高血糖相比，对缺血性中风90天后功能预后的预测潜力。
我们前瞻性纳入了113例因急性缺血性中风住院的2型糖尿病患者。使用便携式AGE-Reader mu©以任意单位测量每位患者前臂的SAF。评估HbA1c及入院后血糖曲线下面积（AUC）。90天后通过电话访谈评估功能预后。预后不良定义为改良Rankin量表评分≥3分。预后良好定义为改良Rankin量表评分<3分或与病前水平相比无恶化。
预后不良的患者SAF值（平均3.38（标准差0.55））高于预后良好的患者（平均3.13（标准差0.61），p = 0.023），但HbA1c和急性血糖水平无差异。在逻辑回归分析中，年龄（p = 0.021，比值比1.24 [1.12 - 1.37]）和SAF（p = 0.021，比值比2.74 [1.16 - 6.46]）显著预测预后不良，而HbA1c和急性血糖则不然。与SAF水平较低且预后良好的患者相比，SAF较高且90天预后不良的患者发生感染的比例更高（4.2% 对33.3%（p < 0.01））以及其他各种院内并发症的比例更高（21.0% 对66.7%（p < 0.01））。
SAF有助于了解血糖记忆，似乎是糖尿病患者中风预后不良的重要预测指标，优于HbA1c和急性血糖。测量SAF可能有助于识别具有并发症和不良预后高风险的特定脆弱患者。
