Admission Glucose Levels May Increase the Risk for Early Neurological Deterioration in Females With Acute Ischemic Stroke

Abstract

Background and purpose: Early neurological deterioration (END) is associated with poor outcome for patients with acute ischemic stroke (AIS). Patients with hyperglycemia have increased risk for stroke and tend to have poor outcome with and without diabetes after stroke. The present study aimed to determine if blood glucose was associated with END and if sex difference was present in the development of END in AIS patients. Methods: A total of 220 consecutive patients (both males and females) with AIS between 2012 and 2015 were screened for this retrospective study. After exclusion, 213 patients were included for analysis. Propensity-score matching was used for normalization of variables including stroke severity, time from symptom onset to treatment, and treatment methods. Results: END was present in 68 patients (31.9%). Multivariate regression analysis showed that the risk of END was significantly higher in males with AIS than in females (P < 0.001), and admission blood glucose level was independently associated with END (P < 0.001). However, subgroup analysis demonstrated that admission glucose levels were significantly associated with increased risk for END only in females, but not in males (P = 0.008). When the cutoff value of 107.1 mg/dL was used, the admission blood glucose level had a significant predictive value for END prediction with a sensitivity of 100% and a specificity of 53% in female patients. Conclusions: The data demonstrated that sex difference was present for the development of END in AIS patients with an increased risk for males. The present study also showed that admission glucose level could be an important predicting factor for END in female patients with AIS.

Early neurological deterioration in acute ischemic stroke patients after intravenous thrombolysis with alteplase predicts poor 3-month functional prognosis - data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China)

“…Our study aimed to explore the risk factors of END and the relationship between END and poor 3-month functional outcomes. In some studies, the incidence of END was significantly different due to the lack of a unified definition of END, which was from 5.8 to 34.9% [ 12 – 15 ]. Most studies have defined END as an increasing NIHSS score ≥ 4 points or death within 24 hours after intravenous thrombolysis, which was our study’s exact definition of END [ 8 , 16 ].…”

The Stress Hyperglycemia Ratio is Associated with Hemorrhagic Transformation in Patients with Acute Ischemic Stroke

“… 34–37 Persistent hyperglycemia is an independent risk factor of infarct expansion 38 and induces early neurological deterioration as well as impairment of cerebral collateral flow. 35 , 39 And patients with dyslipidemia may have an increased risk of incident stroke and recurrent ischemic events, which can worsen the condition of AIS. 40–42 Several studies have investigated acute hyperglycemia predicts increased risk of in-hospital mortality and long-term prognosis after ischemic stroke in non-diabetic patients.…”

New-Onset Diabetes in COVID-19: Time to Frame Its Fearful Symmetry

“…Similarly, a correlation of plasma glucose on admission with radiographic evidence of acute respiratory distress syndrome (ARDS) irrespective of prior DM or no DM has been documented [ 14 ]. Perhaps, the latter is hardly surprising, given the established observation that new-onset hyperglycaemia may result from various clinical conditions, notably HIV and other viral infections [ 15 , 16 ], organ transplantation [ 17 ], stroke [ 18 ] and myocardial infarction [ 19 ]. Of note, in such conditions new hyperglycaemia portends a very sinister prognosis.…”