Effect of Stress Hyperglycemia on Neurological Deficit and Mortality in the Acute Ischemic Stroke People With and Without Diabetes

Abstract

Objective: To determine the relationship between stress hyperglycemia and prognosis of acute ischemic stroke people with and without diabetes. Methods: A subgroup of 8,622 acute ischemic stroke people with baseline levels of fasting blood glucose and HbA1c from the China National Stroke Registry II were analyzed. Stress hyperglycemia was measured by glucose/glycated hemoglobin (HbA1c) ratio, calculated by fasting blood glucose divided by HbA1c. Diabetes was diagnosed according to medical history or a HbA1c level of ≥6.5%. The outcomes included severe neurological deficit defined as modified Rankin Scale score of 3 to 5 and all-cause death at 1 year. The associations between glucose/HbA1c ratio and neurological deficit and all-cause death were analyzed via logistic regression model and Cox proportional-hazards model, respectively. Subgroup analyses of participants with or without diabetes were performed separately. Results: Totally 1,189 (13.7%) participants had severe neurological deficit, and 678 (7.9%) died within 1 year. Compared with the lowest quartile, the highest quartiles of glucose/HbA1c ratio were associated with elevated risk of worse neurological deficit (20.1% vs. 13.0%; adjusted OR, 1.83; 95%CI, 1.31-2.54, p = 0.001), and mortality (12.1% vs. 6.6%; adjusted HR, 2.04; 95% CI, 1.47-2.83, p < 0.0001) after adjusted for potential covariates. The association of glucose/HbA1c ratio with neurological deficit remained in the participants with and without diabetes, while it was only significant in the participants without diabetes as for the outcome of mortality. Conclusions: Stress hyperglycemia, measured by glucose/HbA1c ratio, was associated with increased risk of severe neurological deficit and mortality within 1 year in the acute ischemic stroke people.

Admission Random Blood Glucose, Fasting Blood Glucose, Stress Hyperglycemia Ratio, and Functional Outcomes in Patients With Acute Ischemic Stroke Treated With Intravenous Thrombolysis

“…However, Hempe et al (2010) pointed out that the term “eAG” should be used carefully for clinical practice due to discrepancies between eAG and self-monitored mean blood glucose. Another definition of SHR using the glucose/HbA1c ratio was more practical and widely applied in many studies ( Zhu et al, 2019 ; Li et al, 2020 ; Merlino et al, 2020 ; Yuan et al, 2021 ).…”

Monocyte to High-Density Lipoprotein Ratio Is Associated With Early Neurological Deterioration in Acute Isolated Pontine Infarction

“…Approximately one-third of stroke patients had hyperglycemia on admission, which was associated with a poor prognosis in patients treated with thrombolytic drugs after ischemic stroke. A recent study reported that stress hyperglycemia increases the risk of severe neurological dysfunction in patients with acute ischemic stroke and is associated with mortality within 1 year ( 45 ). Although the exact mechanism underlying the relationship between hyperglycemia and END remains unknown, studies have illuminated the involvement of endothelial injury, tissue acidosis, blood–brain barrier destruction, and production of excessive active oxygen species ( 46 , 47 ).…”

RNA-seq analysis of ischemia stroke and normal brain in a tree shrew model with or without type 2 diabetes mellitus

“…Under acute stress, the stress-induced hyperglycemia is a common physiological response that usually refers to transient hyperglycemia (Yuan et al 2021). In the population, stress-induced hyperglycemia occurs in approximately half of patients with acute ischemic stroke, and it is generally believed to be associated with an increased risk of death and poor neurological prognosis (Li et al 2020). The potential mechanism included hypothalamic-pituitary-adrenal (HPA) axis activation, glucocorticoids release and the sympathetic nervous system activation, that leading to catecholamine-mediated hyperglycemia.…”