Zafar Azra, Albakr Aishah, Shahid Rizwana, Alkhamis Fahd, Alabdali Majed, Aljaafari Danah, Nazish Saima, AlShamrani Foziah Jabbar Gossab, Shariff Erum, Zeeshan Mohammad, AlSulaiman Abdulla, AlAmri Abdullah Saleh, Aldehailan Anas Salman, Al-Jehani Hosam
Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Department of Medical Education, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Front Neurol. 2023 Sep 27;14:1249535. doi: 10.3389/fneur.2023.1249535. eCollection 2023.
This study aimed to investigate the effect of the glycated hemoglobin A1c (HbA1c) level on the functional outcome (FOC) in patients with intracranial large artery atherosclerotic disease (ICLAD)-related acute ischemic stroke (AIS).
This retrospective study enrolled patients with ICLAD-related AIS who were admitted to King Fahd University Hospital between January 2017 and September 2021. Patients were divided into two groups based on the optimal cutoff HbA1c level determined using receiver operating characteristic curve analysis-those with HbA1c ≤6.9% and those with HbA1c >6.9%. Demographic and other clinical characteristics were compared between the two groups using chi-square tests. The association between HbA1c and 90-day FOC was assessed using the chi-square test and odds ratios (ORs). Multivariate analysis was performed to adjust for confounding factors.
A total of 140 patients were included in the analysis. A significant association was observed between the HbA1c level and FOC. Compared to patients with HbA1c ≤6.9%, patients with HbA1c >6.9% were more likely to have an unfavorable FOC [ = <0.001, OR = 2.05, 95% confidence interval (CI) = 1.33-3.14]. The association between HbA1c >6.9% and unfavorable FOC was sustained even after adjusting for confounding factors ( = 0.008) and atherosclerosis risk factors ( = 0.01). HbA1c >6.9% was also associated with higher ORs for in-hospital complications ( = 0.06, OR = 1.34, 95% CI = 1.02-1.77) and mortality ( = 0.07, OR = 1.42, 95% CI = 1.06-1.92) although these associations did not attain significant -values.
HbA1c >6.9% was significantly associated with unfavorable FOC in ICLAD-related AIS. However, further studies with larger sample sizes are required to verify whether HbA1c is an independent predictor of poor FOC. Nevertheless, targeting HbA1c <7% should be the goal of physicians when managing patients at high risk of ICLAD.
本研究旨在探讨糖化血红蛋白A1c（HbA1c）水平对颅内大动脉粥样硬化性疾病（ICLAD）相关急性缺血性卒中（AIS）患者功能结局（FOC）的影响。
这项回顾性研究纳入了2017年1月至2021年9月期间入住法赫德国王大学医院的ICLAD相关AIS患者。根据使用受试者工作特征曲线分析确定的最佳截断HbA1c水平，将患者分为两组——HbA1c≤6.9%的患者和HbA1c>6.9%的患者。使用卡方检验比较两组之间的人口统计学和其他临床特征。使用卡方检验和比值比（OR）评估HbA1c与90天FOC之间的关联。进行多变量分析以调整混杂因素。
共有140名患者纳入分析。观察到HbA1c水平与FOC之间存在显著关联。与HbA1c≤6.9%的患者相比，HbA1c>6.9%的患者更有可能出现不良FOC[P = <0.001，OR = 2.05，95%置信区间（CI）= 1.33 - 3.14]。即使在调整混杂因素（P = 0.008）和动脉粥样硬化危险因素（P = 0.01）后，HbA1c>6.9%与不良FOC之间的关联仍然存在。HbA1c>6.9%还与更高的住院并发症OR相关（P = 0.06，OR = 1.34，95% CI = 1.02 - 1.77）和死亡率（P = 0.07，OR = 1.42，95% CI = 1.06 - 1.92），尽管这些关联未达到显著的P值。
在ICLAD相关AIS中，HbA1c>6.9%与不良FOC显著相关。然而，需要进一步的大样本研究来验证HbA1c是否是不良FOC的独立预测因素。尽管如此，将HbA1c<7%作为目标应是医生管理ICLAD高危患者时的目标。
