Duan Honglian, Yun Ho Jun, Rajah Gary Benjamin, Che Fengli, Wang Yanling, Liu Jing, Tong Yanna, Cheng Zhe, Cai Lipeng, Geng Xiaokun, Ding Yuchuan
Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, School of Medicine, Wayne State University, Detroit, MI, United States.
Front Neurosci. 2023 Jan 27;17:1073924. doi: 10.3389/fnins.2023.1073924. eCollection 2023.
This study assesses whether stress-induced hyperglycemia is a predictor of poor outcome at 3 months for patients with acute ischemic stroke (AIS) treated by endovascular treatment (EVT) and impacted by their previous blood glucose status.
This retrospective study collected data from 576 patients with AIS due to large vessel occlusion (LVO) treated by EVT from March 2019 to June 2022. The sample was composed of 230 and 346 patients with and without diabetes mellitus (DM), respectively, based on their premorbid diabetic status. Prognosis was assessed with modified Rankin Scale (mRS) at 3-month after AIS. Poor prognosis was defined as mRS>2. Stress-induced hyperglycemia was assessed by fasting glucose-to-glycated hemoglobin ratio (GAR). Each group was stratified into four groups by quartiles of GAR (Q1-Q4). Binary logistic regression analysis was used to identify relationship between different GAR quartiles and clinical outcome after EVT.
In DM group, a poor prognosis was seen in 122 (53%) patients and GAR level was 1.27 ± 0.44. These variables were higher than non-DM group and the differences were statistically significant ( < 0.05, respectively). Patients with severe stress-induced hyperglycemia demonstrated greater incidence of 3-month poor prognosis (DM: Q1, 39.7%; Q2, 45.6%; Q3, 58.6%; Q4, 68.4%; = 0.009. Non-DM: Q1, 31%; Q2, 32.6%; Q3, 42.5%; Q4, 64%; < 0.001). However, the highest quartile of GAR was independently associated with poor prognosis at 3 months (OR 3.39, 95% CI 1.66-6.96, = 0.001), compared to the lowest quartile in non-DM patients after logistic regression. This association was not observed from DM patients.
The outcome of patients with acute LVO stroke treated with EVT appears to be influenced by premorbid diabetes status. However, the poor prognosis at 3-month in patients with DM is not independently correlated with stress-induced hyperglycemia. This could be due to the long-term damage of persistent hyperglycemia and diabetic patients' adaptive response to stress following acute ischemic damage to the brain.
本研究评估应激性高血糖是否是接受血管内治疗（EVT）的急性缺血性卒中（AIS）患者3个月预后不良的预测因素，以及其是否受患者既往血糖状态的影响。
这项回顾性研究收集了2019年3月至2022年6月期间576例因大血管闭塞（LVO）接受EVT治疗的AIS患者的数据。根据患者病前糖尿病状态，样本分别由230例和346例患有和未患有糖尿病（DM）的患者组成。在AIS发病3个月后用改良Rankin量表（mRS）评估预后。预后不良定义为mRS>2。通过空腹血糖与糖化血红蛋白比值（GAR）评估应激性高血糖。每组根据GAR四分位数（Q1-Q4）分为四组。采用二元逻辑回归分析确定不同GAR四分位数与EVT后临床结局之间的关系。
在糖尿病组中，122例（53%）患者预后不良，GAR水平为1.27±0.44。这些变量高于非糖尿病组，差异具有统计学意义（分别<0.05）。严重应激性高血糖患者3个月预后不良的发生率更高（糖尿病组：Q1，39.7%；Q2，45.6%；Q3，58.6%；Q4，68.4%；P=0.009。非糖尿病组：Q1，31%；Q2，32.6%；Q3，42.5%；Q4，64%；P<0.001）。然而，与非糖尿病患者最低四分位数相比，GAR最高四分位数与3个月时预后不良独立相关（OR 3.39，95%CI 1.66-6.96，P=0.001），这是在逻辑回归分析后得出的。在糖尿病患者中未观察到这种关联。
接受EVT治疗的急性LVO卒中患者的预后似乎受病前糖尿病状态的影响。然而，糖尿病患者3个月时的预后不良与应激性高血糖无独立相关性。这可能是由于持续性高血糖的长期损害以及糖尿病患者在脑急性缺血损伤后对应激的适应性反应。
