Alabdali Majed Mohammad, Alrasheed Abdulrahim Saleh, Alghirash Fatimah Ahmed, Almaqboul Taif Mansour, Alhashim Ali, Aljaafari Danah Tareq, Alqarni Mustafa Ahmed
Neurology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Khobar 34445, Saudi Arabia.
Department of Neurosurgery, College of Medicine, King Faisal University, AlAhsa 31982, Saudi Arabia.
Biomedicines. 2025 Jul 28;13(8):1834. doi: 10.3390/biomedicines13081834.
Stress hyperglycemia (SH), a transient elevation in blood glucose levels during acute stress such as stroke, has been increasingly recognized as a critical determinant of clinical outcomes. This review aims to evaluate the association between SH and clinical outcomes across different stroke subtypes and its role as a prognostic indicator. The current literature review was conducted through a comprehensive literature search of PubMed, Scopus, and Web of Science electronic databases. Initial title and abstract screening was conducted by two independent reviewers depending on the relevance to the topic of interest. Final study inclusion was based on the clinical relevance and agreement between reviewers. Current evidence links SH with higher stroke severity (Higher national institutes of health stroke scale (NIHSS)), larger infarct volumes, increased risk of hemorrhagic transformation, and worse functional recovery (Lower modified rankin scale (mRS)), especially in ischemic stroke. In hemorrhagic stroke, SH is associated with hematoma expansion, perihematomal edema, and worsening neurological function. Although SH has been shown to be a reliable stroke outcome predictor, there is no scientific consensus regarding the most reliable measurement method. The use of absolute blood glucose values may not accurately reflect SH, particularly in diabetic patients, where chronic baseline hyperglycemia complicates interpretation. This underscores the necessity for individualized assessment rather than a uniform interpretation. Clinically, the early detection of SH may provide enhanced monitoring and supportive care; however, rigorous glucose management remains contentious due to the risk of hypoglycemia. This review synthesizes evidence from recent studies and supports SH as a prognostic marker of both short- and long-term adverse outcomes in stroke patients. Further research is warranted to evaluate the efficacy of targeted glycemic treatments on such outcomes.
应激性高血糖（SH）是指在中风等急性应激期间血糖水平的短暂升高，现已越来越被视为临床结局的关键决定因素。本综述旨在评估不同中风亚型中SH与临床结局之间的关联及其作为预后指标的作用。通过对PubMed、Scopus和Web of Science电子数据库进行全面的文献检索，开展了本次文献综述。由两名独立审稿人根据与感兴趣主题的相关性进行初步标题和摘要筛选。最终纳入研究基于审稿人之间的临床相关性和一致性。目前的证据表明，SH与更高的中风严重程度（更高的美国国立卫生研究院卒中量表（NIHSS））、更大的梗死体积、出血转化风险增加以及更差的功能恢复（更低的改良Rankin量表（mRS））相关，尤其是在缺血性中风中。在出血性中风中，SH与血肿扩大、血肿周围水肿和神经功能恶化有关。尽管SH已被证明是可靠的中风结局预测指标，但关于最可靠的测量方法尚无科学共识。使用绝对血糖值可能无法准确反映SH，尤其是在糖尿病患者中，慢性基线高血糖会使解读变得复杂。这凸显了个体化评估而非统一解读的必要性。临床上，早期检测SH可能有助于加强监测和支持性护理；然而，由于存在低血糖风险，严格的血糖管理仍存在争议。本综述综合了近期研究的证据，并支持SH作为中风患者短期和长期不良结局的预后标志物。有必要进一步研究以评估针对性血糖治疗对这些结局的疗效。
