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Stress hyperglycemia is predictive of worse outcome in patients with acute ischemic stroke undergoing intravenous thrombolysis

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Abstract

No study investigated the possible detrimental effect of stress hyperglycemia on patients affected acute ischemic stroke (AIS) undergoing intravenous thrombolysis (IVT). A new index, the glucose-to-glycated hemoglobin ratio (GAR), has been developed for assessing stress hyperglycemia. We retrospectively analyzed data from a prospectively collected database of consecutive patients admitted to the Udine University Hospital with AIS that were treated with IVT from January 2015 to December 2019. Four hundred and fourteen consecutive patients with AIS undergoing IVT entered the study. The patients were then stratified into four groups by quartiles of GAR (Q1–Q4). The higher GAR index was, the more severe stress hyperglycemia was considered. Prevalence of 3 months poor outcome (37.7% for Q1, 34% for Q2, 46.9% for Q3, and 66.7% for Q4, p for trend = 0.001), 3 months mortality (10.5% for Q1, 7.5% for Q2, 11.2% for Q3, and 27.1% for Q4, p for trend = 0.001), and symptomatic intracranial hemorrhage (0.9% for Q1, 0.9% for Q2, 5.1% for Q3, and 17.7% for Q4, p for trend = 0.001) was significant different among the four groups. AIS patients with severe stress hyperglycemia had a significantly increased risk of 3 months poor outcome (OR 2.43, 95% CI 1.14–5.22, p = 0.02), 3 months mortality (OR 2.38, 95% CI 1.01–5.60, p = 0.04), and symptomatic intracranial hemorrhage (OR 16.76, 95% CI 2.09–134.58, p = 0.008) after IVT. In conclusion, we demonstrated that stress hyperglycemia, as measured by the GAR index, is associated to worse outcome in AIS patients undergoing IVT.

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Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Giovanni Merlino and Carmelo Smeralda have contributed equally to this work.

Authors and Affiliations

  1. Stroke Unit, Department of Neuroscience, Udine University Hospital, Piazzale S. Maria della Misericordia 15, 33100, Udine, Italy

    Giovanni Merlino & Simone Lorenzut

  2. Clinical Neurology, Udine University Hospital, Udine, Italy

    Giovanni Merlino, Carmelo Smeralda, Gian Luigi Gigli, Sara Pez, Andrea Surcinelli, Alessandro Marini & Mariarosaria Valente

  3. DAME, University of Udine, Udine, Italy

    Carmelo Smeralda, Sara Pez, Andrea Surcinelli, Alessandro Marini & Mariarosaria Valente

  4. DMIF, University of Udine, Udine, Italy

    Gian Luigi Gigli

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  1. Giovanni Merlino
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  2. Carmelo Smeralda
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Contributions

Conceptualization, GM and CS; methodology, GM and CS; software, CS and SL; validation, SL, GLG and MV; formal analysis, GM; investigation, CS, SL, SP, AS, and AM; resources, CS, SL, SP, AS and AM; data curation, GM; writing—original draft preparation, GM; writing—review and editing, GM; visualization, GLG; supervision, MV.

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Correspondence to Giovanni Merlino.

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Merlino, G., Smeralda, C., Gigli, G.L. et al. Stress hyperglycemia is predictive of worse outcome in patients with acute ischemic stroke undergoing intravenous thrombolysis. J Thromb Thrombolysis 51, 789–797 (2021). https://doi.org/10.1007/s11239-020-02252-y

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  • DOI: https://doi.org/10.1007/s11239-020-02252-y

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