Fasting blood glucose-to-glycated hemoglobin ratio and all-cause mortality among Chinese in-hospital patients with acute stroke: a 12-month follow-up study

Abstract

Background Stroke is a leading cause of death and functional impairment in older people. To assess the prospective association between fasting blood glucose-to-glycated hemoglobin ratio and all-cause mortality and poor prognosis in stroke patients. Methods A total of 971 Chinese inpatients with acute stroke (mean age of 65.7) were consecutively enrolled in the prospective clinical study and followed up for 12 months after discharge. Stress hyperglycemia was measured using the ratio of fasting blood glucose (FBG, mmol/L)/glycated hemoglobin (HbA1c, %). The primary outcome was all-cause mortality, and secondary outcomes were poor prognosis defined as infectious complications, a National Institutes of Health Stroke Scale (NIHSS) score ≥ 6, a Barthel Index score ≤ 60, or a modified Rankin Scale (mRS) score of 3–6, presented as multivariate-adjusted odds ratios (ORs) with 95% confidence intervals (CIs) across the quartiles of the FBG/HbA1c ratio. Results There were 35 (4.1%) all-cause deaths at 3 months and 85 (11.4%) at 12 months. The inpatients with the highest quartile of the FBG/HbA1c ratio had a higher risk of all-cause death at 3 months (adjusted OR: 5.16, 95% CI: 1.03–25.74) and at 12 months (adjusted OR: 2.59, 95% CI: 1.14–5.89)) and a higher risk of infectious complications (adjusted OR 2.37, 95% CI 1.27–4.43) and dysfunction (adjusted OR 1.79, 95% CI 1.06–3.01) during hospitalization than inpatients with the lowest quartile. Conclusions Stress hyperglycemia, measured by the FBG/HbA1c ratio, was associated with an increased risk of adverse outcomes, including all-cause death, infectious complications, and dysfunction after stroke.

Association of glycemic gap with stroke recurrence in patients with ischemic stroke

“…30 Another prospective study indicated that a higher quartile of stress hyperglycemia was related to a higher risk of all-cause death after stroke. 31 T A B L E 2 Hazard ratios for stroke recurrence according to the glycemic gap. The potential mechanisms of the association between the glycemic gap and stroke recurrence might be explained as follows.…”

“…Roberts et al suggested that stress hyperglycemia was associated with poor functional outcome in patients with ischemic stroke 30 . Another prospective study indicated that a higher quartile of stress hyperglycemia was related to a higher risk of all‐cause death after stroke 31 …”

“… 30 Another prospective study indicated that a higher quartile of stress hyperglycemia was related to a higher risk of all‐cause death after stroke. 31 …”

Association of baseline fasting plasma glucose with 1-year mortality in non-diabetic patients with acute cerebral infarction: a multicentre observational cohort study

“…7 Both their study and ours suggest that higher fasting blood glucose is associated with an increased mortality risk in non-diabetic patients with ACI. Stress hyperglycaemia was measured by FBG/HbA1c ratio in a study by Cai et al 24 Their study showed that patients in the highest quartile of the FBG/HbA1c ratio had an increased risk of all-cause death at 3 months (OR: 5.16) and at 12 months (OR: 2.59) after stroke. In contrast, our results showed that the 3-month all-cause mortality in Q4 (>5.55 mmol/L) was significantly increased compared with Q1 (<4.52 mmol/L).…”