Advertisement

Neurocritical Care

, Volume 29, Issue 3, pp 426–434 | Cite as

Effects of Diabetes Mellitus and Admission Glucose in Patients Receiving Mechanical Thrombectomy: A Systematic Review and Meta-analysis

  • Guang-Dong Lu
  • Zi-Qi Ren
  • Jin-Xing Zhang
  • Qing-Quan Zu
  • Hai-Bin Shi
Original Article

Abstract

Background

We performed a meta-analysis to evaluate the outcomes of acute ischemic stroke (AIS) in patients treated with mechanical thrombectomy (MT), according to diabetes mellitus and admission glucose level (AGL).

Methods

We systematically reviewed previous studies in PubMed that reported outcomes of MT in AIS patients and their relationships with diabetes mellitus or AGL. We used functional independence (modified Rankin score ≤ 2 at 3 months) as the primary end point.

Results

Data from 12,653 patients in 47 articles that evaluated the effect of diabetes mellitus or AGL on outcomes after MT were included. Compared with patients without a history of diabetes mellitus, patients with a diabetes mellitus history had significantly lower odds of functional independence in both the unadjusted meta-analysis (odds ratio [OR] 0.64; 95% confidence interval [CI] 0.54–0.75) and the multivariable analysis (OR 0.48; 95% CI 0.33–0.71). Similarly, higher AGL was associated with an unfavorable functional outcome in the unadjusted meta-analysis (pooled effect size − 0.38; 95% CI − 0.45 to − 0.31), and the adjusted OR (95% CI) per 1 mmol/L increase in AGL was 0.87 (0.83–0.92) for functional independence according to the combined multivariable results. Recanalization rate and symptomatic intracranial hemorrhage were neither related to AGL nor different in patients with or without diabetes mellitus.

Conclusions

The present study confirms that a history of diabetes mellitus and high AGL are associated with unfavorable functional outcomes at 3 months after MT in AIS patients. However, the causal relationship between hyperglycemia and poor prognosis remains undetermined, and further investigations are required to ascertain whether AIS patients receiving MT could benefit from intensive glucose control.

Keywords

Acute ischemic stroke Mechanical thrombectomy Diabetes mellitus Admission glucose Meta-analysis 

Notes

Acknowledgements

We would like to thank Jin Xu from Nanjing Medical University for his advices on statistical analysis.

Author Contributions

GDL was responsible for study design, literature search, data extraction, data analysis and manuscript drafting. ZQR was responsible for literature search, data extraction and manuscript drafting. JXZ was responsible for data analysis and manuscript drafting. QQZ was responsible for manuscript drafting and manuscript revision. HBS was responsible for study design, study supervision, manuscript drafting and manuscript revision.

Source of Support

This research received no specific grant from any funding agency.

Compliance with ethical standards

Conflict of interest

All authors have no conflict of interest to declare.

Supplementary material

12028_2018_562_MOESM1_ESM.docx (58 kb)
Supplementary material 1 (DOCX 58 kb)

References

  1. 1.
    Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372:11–20.CrossRefGoogle Scholar
  2. 2.
    Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372:1009–18.CrossRefGoogle Scholar
  3. 3.
    Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372:1019–30.CrossRefGoogle Scholar
  4. 4.
    Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372:2285–95.CrossRefGoogle Scholar
  5. 5.
    Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372:2296–306.CrossRefGoogle Scholar
  6. 6.
    Bracard S, Ducrocq X, Mas JL, et al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol. 2016;15:1138–47.CrossRefGoogle Scholar
  7. 7.
    Desilles JP, Meseguer E, Labreuche J, et al. Diabetes mellitus, admission glucose, and outcomes after stroke thrombolysis: a registry and systematic review. Stroke. 2013;44:1915–23.CrossRefGoogle Scholar
  8. 8.
    Demchuk AM, Morgenstern LB, Krieger DW, et al. Serum glucose level and diabetes predict tissue plasminogen activator-related intracerebral hemorrhage in acute ischemic stroke. Stroke. 1999;30:34–9.CrossRefGoogle Scholar
  9. 9.
    Bruno A, Levine SR, Frankel MR, et al. Admission glucose level and clinical outcomes in the NINDS rt-PA Stroke Trial. Neurology. 2002;59:669–74.CrossRefGoogle Scholar
  10. 10.
    Ribo M, Molina C, Montaner J, et al. Acute hyperglycemia state is associated with lower tPA-induced recanalization rates in stroke patients. Stroke. 2005;36:1705–9.CrossRefGoogle Scholar
  11. 11.
    Masrur S, Cox M, Bhatt DL, et al. Association of acute and chronic hyperglycemia with acute ischemic stroke outcomes post-thrombolysis: findings from get with the guidelines-stroke. J Am Heart Assoc. 2015;4:e002193.CrossRefPubMedGoogle Scholar
  12. 12.
    Kamada H, Yu F, Nito C, Chan PH. Influence of hyperglycemia on oxidative stress and matrix metalloproteinase-9 activation after focal cerebral ischemia/reperfusion in rats: relation to blood-brain barrier dysfunction. Stroke. 2007;38:1044–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Ennis SR, Keep RF. Effect of sustained-mild and transient-severe hyperglycemia on ischemia-induced blood-brain barrier opening. J Cereb Blood Flow Metab. 2007;27:1573–82.CrossRefPubMedGoogle Scholar
  14. 14.
    Suh SW, Shin BS, Ma H, et al. Glucose and NADPH oxidase drive neuronal superoxide formation in stroke. Ann Neurol. 2008;64:654–63.CrossRefPubMedGoogle Scholar
  15. 15.
    Kawai N, Keep RF, Betz AL. Hyperglycemia and the vascular effects of cerebral ischemia. Stroke. 1997;28:149–54.CrossRefGoogle Scholar
  16. 16.
    Martini SR, Kent TA. Hyperglycemia in acute ischemic stroke: a vascular perspective. J Cereb Blood Flow Metab. 2007;27:435–51.CrossRefGoogle Scholar
  17. 17.
    Kim JT, Jahan R, Saver JL. Impact of glucose on outcomes in patients treated with mechanical thrombectomy: a post hoc analysis of the solitaire flow restoration with the intention for thrombectomy study. Stroke. 2016;47:120–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Osei E, den Hertog HM, Berkhemer OA, et al. Admission glucose and effect of intra-arterial treatment in patients with acute ischemic stroke. Stroke. 2017;48:1299–305.CrossRefPubMedGoogle Scholar
  19. 19.
    Chinn S. A simple method for converting an odds ratio to effect size for use in meta-analysis. Stat Med. 2000;19:3127–31.CrossRefPubMedGoogle Scholar
  20. 20.
    Egger M, Davey SG, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.CrossRefPubMedGoogle Scholar
  21. 21.
    de Courten-Myers G, Myers RE, Schoolfield L. Hyperglycemia enlarges infarct size in cerebrovascular occlusion in cats. Stroke. 1988;19:623–30.CrossRefGoogle Scholar
  22. 22.
    de Courten-Myers GM, Kleinholz M, Wagner KR, Myers RE. Normoglycemia (not hypoglycemia) optimizes outcome from middle cerebral artery occlusion. J Cereb Blood Flow Metab. 1994;14:227–36.CrossRefGoogle Scholar
  23. 23.
    Parsons MW, Barber PA, Desmond PM, et al. Acute hyperglycemia adversely affects stroke outcome: a magnetic resonance imaging and spectroscopy study. Ann Neurol. 2002;52:20–8.CrossRefGoogle Scholar
  24. 24.
    Els T, Klisch J, Orszagh M, et al. Hyperglycemia in patients with focal cerebral ischemia after intravenous thrombolysis: influence on clinical outcome and infarct size. Cerebrovasc Dis. 2002;13:89–94.CrossRefGoogle Scholar
  25. 25.
    Yip PK, He YY, Hsu CY, Garg N, Marangos P, Hogan EL. Effect of plasma glucose on infarct size in focal cerebral ischemia-reperfusion. Neurology. 1991;41:899–905.CrossRefGoogle Scholar
  26. 26.
    Bellolio MF, Gilmore RM, Ganti L. Insulin for glycaemic control in acute ischaemic stroke. Cochrane Database Syst Rev. 2014.  https://doi.org/10.1002/14651858.CD005346.pub4.CrossRefGoogle Scholar
  27. 27.
    McCormick M, Hadley D, McLean JR, Macfarlane JA, Condon B, Muir KW. Randomized, controlled trial of insulin for acute poststroke hyperglycemia. Ann Neurol. 2010;67:570–8.Google Scholar
  28. 28.
    Bruno A, Kent TA, Coull BM, et al. Treatment of hyperglycemia in ischemic stroke (THIS): a randomized pilot trial. Stroke. 2008;39:384–9.CrossRefGoogle Scholar
  29. 29.
    Staszewski J, Brodacki B, Kotowicz J, Stepien A. Intravenous insulin therapy in the maintenance of strict glycemic control in nondiabetic acute stroke patients with mild hyperglycemia. J Stroke Cerebrovasc Dis. 2011;20:150–4.CrossRefGoogle Scholar
  30. 30.
    Gray CS, Hildreth AJ, Sandercock PA, et al. Glucose-potassium-insulin infusions in the management of post-stroke hyperglycaemia: the UK Glucose Insulin in Stroke Trial (GIST-UK). Lancet Neurol. 2007;6:397–406.CrossRefGoogle Scholar
  31. 31.
    Walters MR, Weir CJ, Lees KR. A randomised, controlled pilot study to investigate the potential benefit of intervention with insulin in hyperglycaemic acute ischaemic stroke patients. Cerebrovasc Dis. 2006;22:116–22.CrossRefGoogle Scholar
  32. 32.
    Kreisel SH, Berschin UM, Hammes HP, et al. Pragmatic management of hyperglycaemia in acute ischaemic stroke: safety and feasibility of intensive intravenous insulin treatment. Cerebrovasc Dis. 2009;27:167–75.CrossRefGoogle Scholar
  33. 33.
    Johnston KC, Hall CE, Kissela BM, Bleck TP, Conaway MR. Glucose Regulation in Acute Stroke Patients (GRASP) trial: a randomized pilot trial. Stroke. 2009;40:3804–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Piironen K, Putaala J, Rosso C, Samson Y. Glucose and acute stroke: evidence for an interlude. Stroke. 2012;43:898–902.CrossRefGoogle Scholar
  35. 35.
    Ribo M, Molina CA, Delgado P, et al. Hyperglycemia during ischemia rapidly accelerates brain damage in stroke patients treated with tPA. J Cereb Blood Flow Metab. 2007;27:1616–22.CrossRefPubMedGoogle Scholar
  36. 36.
    Ntaios G, Egli M, Faouzi M, Michel P. J-shaped association between serum glucose and functional outcome in acute ischemic stroke. Stroke. 2010;41:2366–70.CrossRefPubMedGoogle Scholar
  37. 37.
    Mandava P, Martini SR, Munoz M, et al. Hyperglycemia worsens outcome after rt-PA primarily in the large-vessel occlusive stroke subtype. Transl Stroke Res. 2014;5:519–25.CrossRefGoogle Scholar
  38. 38.
    Bruno A, Durkalski VL, Hall CE, et al. The Stroke Hyperglycemia Insulin Network Effort (SHINE) trial protocol: a randomized, blinded, efficacy trial of standard vs. intensive hyperglycemia management in acute stroke. Int J Stroke. 2014;9:246–51.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2018

Authors and Affiliations

  1. 1.Department of Interventional RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
  2. 2.School of NursingNanjing Medical UniversityNanjingChina

Personalised recommendations