Endocrinology and Nutrition Department, Hospital del Mar, Barcelona, Spain.
IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Cardiovasc Diabetol. 2024 Jun 18;23(1):206. doi: 10.1186/s12933-024-02260-9.
Elevated plasma glucose levels are common in patients suffering acute ischemic stroke (AIS), and acute hyperglycemia has been defined as an independent determinant of adverse outcomes. The impact of acute-to-chronic glycemic ratio (ACR) has been analyzed in other diseases, but its impact on AIS prognosis remains unclear. The main aim of this study was to assess whether the ACR was associated with a 3-month poor prognosis in patients with AIS.
RESEARCH, DESIGN AND METHODS: Retrospective analysis of patients admitted for AIS in Hospital del Mar, Barcelona. To estimate the chronic glucose levels (CGL) we used the formula eCGL= [28.7xHbA1c (%)]-46.7. The ACR (glycemic at admission / eCGL) was calculated for all subjects. Tertile 1 was defined as: 0.28-0.92, tertile 2: 0.92-1.13 and tertile 3: > 1.13. Poor prognosis at 3 months after stroke was defined as mRS score 3-6.
2.774 subjects with AIS diagnosis were included. Age, presence of diabetes, previous disability (mRS), initial severity (NIHSS) and revascularization therapy were associated with poor prognosis (p values < 0.05). For each 0.1 increase in ACR, there was a 7% increase in the risk of presenting a poor outcome. The 3rd ACR tertile was independently associated with a poor prognosis and mortality. In the ROC curves, adding the ACR variable to the classical clinical model did not increase the prediction of AIS prognosis (0.786 vs. 0.781).
ACR was positively associated with a poor prognosis and mortality at 3-months follow-up after AIS. Subjects included in the 3rd ACR tertile presented a higher risk of poor prognosis and mortality. Baseline glucose or ACR did not add predictive value in comparison to only using classical clinical variables.
急性缺血性脑卒中（AIS）患者常伴有血浆葡萄糖水平升高，急性高血糖已被定义为不良预后的独立决定因素。急性与慢性血糖比值（ACR）在其他疾病中的影响已被分析，但它对 AIS 预后的影响尚不清楚。本研究的主要目的是评估 ACR 是否与 AIS 患者 3 个月预后不良相关。
回顾性分析巴塞罗那 Hospital del Mar 医院收治的 AIS 患者。为了估计慢性血糖水平（CGL），我们使用公式 eCGL= [28.7xHbA1c（%）]-46.7。对所有患者计算 ACR（入院时血糖值/ eCGL）。第 1 三分位数定义为：0.28-0.92，第 2 三分位数为：0.92-1.13，第 3 三分位数为：>1.13。3 个月后卒中预后不良定义为 mRS 评分 3-6。
共纳入 2774 例 AIS 患者。年龄、糖尿病、既往残疾（mRS）、初始严重程度（NIHSS）和血管再通治疗与不良预后相关（p 值均<0.05）。ACR 每增加 0.1，不良结局的风险增加 7%。第 3 个 ACR 三分位数与不良预后和死亡率独立相关。在 ROC 曲线中，将 ACR 变量加入经典临床模型后并不能提高对 AIS 预后的预测（0.786 与 0.781）。
ACR 与 AIS 后 3 个月的不良预后和死亡率呈正相关。ACR 第 3 三分位数的患者预后不良和死亡率的风险更高。与仅使用经典临床变量相比，基线血糖或 ACR 并未增加预测价值。
