Gao Jie, Chen Xiangliang, Huang Qing, Gu Mengmeng, Hong Ye, Xu Gelin
Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China.
Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China.
Brain Sci. 2025 Mar 30;15(4):360. doi: 10.3390/brainsci15040360.
Stress hyperglycemia may deteriorate stroke outcomes, but its impact on the prognosis following mechanical thrombectomy remains unclear. This study aimed to evaluate the effects of stress hyperglycemia on in-hospital and 3-month outcomes in stroke patients with anterior circulation occlusion undergoing mechanical thrombectomy. A total of 415 patients who had mechanical thrombectomy in the anterior circulation were enrolled. The stress hyperglycemia ratio (SHR) was calculated as the fasting glucose to glycated hemoglobin ratio and was categorized into tertiles (i.e., SHR1-3). In-hospital and 3-month outcomes were compared using multivariable regression models. The impact of SHR stratified by diabetes status was evaluated and the predictive accuracy of the Totaled Health Risks in Vascular Events (THRIVE)-c risk score was explored with the inclusion of SHR. Compared to the SHR1-2 groups, the SHR3 group exhibited significantly higher rates of 24 h symptomatic intracranial hemorrhage (adjusted odds ratio [aOR], 4.088; 95% confidence interval [CI], 1.551-10.772; = 0.004) and 72 h early neurological deterioration (aOR, 3.505; 95% CI, 1.984-6.192; < 0.001), while the incidence of post-stroke pneumonia did not differ significantly between the groups (aOR, 1.379; 95% CI, 0.838-2.268; = 0.206). At three months, the SHR3 group had a worse distribution of modified Rankin scale (aOR, 2.261; 95% CI, 1.495-3.421; < 0.001) and faced a higher risk of functional dependence (adjusted hazard ratio [aHR], 1.629; 95% CI, 1.230-2.158; = 0.001) as well as all-cause mortality (aHR, 1.986; 95% CI, 1.235-3.194; = 0.005). The adverse effects of an elevated SHR were more pronounced in non-diabetic patients, and incorporating SHR significantly enhanced the predictive accuracy of the THRIVE-c score for poor stroke outcomes. Stress hyperglycemia could be related to the risks of in-hospital complications and 3-month poor outcomes following mechanical thrombectomy in the anterior circulation.
应激性高血糖可能会使卒中预后恶化，但其对机械取栓术后预后的影响仍不明确。本研究旨在评估应激性高血糖对接受机械取栓的前循环闭塞性卒中患者院内及3个月预后的影响。共纳入415例行前循环机械取栓的患者。应激性高血糖比值（SHR）通过空腹血糖与糖化血红蛋白比值计算得出，并分为三个三分位数组（即SHR1-3）。采用多变量回归模型比较院内及3个月预后。评估按糖尿病状态分层的SHR的影响，并纳入SHR以探索血管事件总体健康风险（THRIVE）-c风险评分的预测准确性。与SHR1-2组相比，SHR3组24小时症状性颅内出血发生率显著更高（调整优势比[aOR]，4.088；95%置信区间[CI]，1.551-10.772；P = 0.004），72小时早期神经功能恶化发生率也更高（aOR，3.505；95%CI，1.984-6.192；P < 0.001），而卒中后肺炎发生率在两组间无显著差异（aOR，1.379；95%CI，0.838-2.268；P = 0.206）。在3个月时，SHR3组改良Rankin量表评分分布更差（aOR，2.261；95%CI，1.495-3.421；P < 0.001），面临更高的功能依赖风险（调整风险比[aHR]，1.629；95%CI，1.230-2.158；P = 0.001）以及全因死亡率（aHR，1.986；95%CI，1.235-3.194；P = 0.005）。SHR升高的不良影响在非糖尿病患者中更为明显，纳入SHR显著提高了THRIVE-c评分对卒中不良预后的预测准确性。应激性高血糖可能与前循环机械取栓术后的院内并发症风险及3个月不良预后相关。
