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Does stress hyperglycemia in diabetic and non-diabetic acute ischemic stroke patients predict unfavorable outcomes following endovascular treatment?

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Abstract

Background

Hyperglycemia in hospitalized patients is related to increased morbidity and mortality, we determine if stress hyperglycemia, as assessed by the stress hyperglycemia ratio (SHR) index, increases the risk of adverse events in diabetic and non-diabetic AIS (acute ischemic stroke) patients following EVT (endovascular treatment).

Methods

We retrospectively analyzed data of 209 patients who achieved complete recanalization. SHR was defined as [FPG (mmol/L)/HbA1c (%)]. This study comprised 130 non-diabetic AIS patients and 79 people with diabetes, and they were categorized into three different groups based on SHR (Q1–Q3) tertiles. The primary outcome was futile recanalization, characterized as a 3-month modified Rankin scale score (mRS) of 3–6. Multivariable logistic regression analyses were utilized to calculate the relationship between stress hyperglycemia and poor outcomes.

Results

Non-diabetic patients showed statistically significant differences in the proportion of 3-month all-cause mortality (14.6% for Q1, 63.0% for Q2, 74.4% for Q3, p<0.001) and futile recanalization (2.4% for Q1, 19.6% for Q2, 37.2% for Q3, p<0.001) between the three groups. After adjusting for potential confounders, we found that the highest SHR tertile remained an independent risk factor of futile recanalization (OR 18.13, 95% CI 3.38–97.38, p = 0.001) and 3-month all-cause mortality (OR 15.9, 95% CI 1.46–173.26, p = 0.023) among non-diabetic patients. As demonstrated by restricted cubic splines, the SHR reference was 1.12.

Conclusions

Severe stress hyperglycemia independently increased the odds of futile recanalization and 3-month all-cause mortality in AIS patients receiving EVT but without diabetes.

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Data availability

The datasets used and/or analyzed during the current study are available from the first author upon reasonable request.

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Acknowledgments

We thank all the participants in the study and all the staff members. Our study has no support.

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Authors and Affiliations

  1. Jiangsu Taizhou People’s Hospital, Taizhou, 225300, China

    Zhengyang Wang & Lin Fan

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  1. Zhengyang Wang
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All authors have given final approval of the version to be published. In detail: Zhengyang Wang was responsible for the concept and design of the study, data collection and analysis, and the first draft of the paper and further manuscript; Lin Fan was responsible for all aspects of the work in ensuring that questions related to the accuracy.

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Correspondence to Lin Fan.

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The study was approved by the Taizhou People’s Hospital Ethics Committee. No informed consent was required due to the retrospective nature.

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Wang, Z., Fan, L. Does stress hyperglycemia in diabetic and non-diabetic acute ischemic stroke patients predict unfavorable outcomes following endovascular treatment?. Neurol Sci 44, 1695–1702 (2023). https://doi.org/10.1007/s10072-023-06625-y

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