High Stress Hyperglycemia Ratio Predicts Poor Outcome after Mechanical Thrombectomy for Ischemic Stroke

Chen, Xingyu; Liu, Zhaoji; Miao, Jiayin; Zheng, Wei-Hong; Yang, Qianying; Ye, Xiaowen; Zhuang, Xinbo; Peng, Feng

doi:10.1016/j.jstrokecerebrovasdis.2019.02.022

Cited by 52 publications

(71 citation statements)

References 27 publications

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“…Unlike absolutely hyperglycemia, relative measures of hyperglycemia, such as glucose/ HbA1c ratio, reflected the relative acute rapid increase of blood glucose level compared with premorbid glucose status. Previous study showed that such relative measures controlling for background glycemia better predicted prognosis of critical illness than absolute hyperglycemia (6)(7)(8). We previously found that glucose/HbA1c ratio was related to allcause death in people with acute ischemic stroke (9).…”

Section: Discussionmentioning

confidence: 99%

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

Quan

Wang

et al. 2020

Front. Neurol.

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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.

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Section: Discussionmentioning

confidence: 99%

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

Quan

Wang

et al. 2020

Front. Neurol.

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“…Furthermore, reports by Esposito et al and Monnier et al suggested that acute glucose fluctuations induced by SIH could be more harmful than sustained hyperglycaemia [16,17]. To assess the effect of SIH more accurately, glycaemic gap and stress hyperglycaemia ratio (SHR), which eliminates the interference of chronic baseline glycaemic levels, were proposed as a novel index of SIH [18][19][20]. Considerable evidence have confirmed both glycaemic gap and SHR were strongly correlated with adverse cardiovascular outcome in AMI patients [15,21,22], but we knew little about the association between these indexes and post-infarct LVSD.…”

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confidence: 99%

Augmented glycaemic gap is a marker for an increased risk of post-infarct left ventricular systolic dysfunction

Zhu

Liu

Meng

et al. 2020

Cardiovasc Diabetol

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Background: Left ventricular systolic dysfunction (LVSD) occurs frequently after acute ST-segment elevation myocardial infarction (STEMI). The predisposing factors and underlying mechanism of post-infarct LVSD are not fully understood. The present study mainly investigated the correlation between glycaemic gap, a novel index of stressinduced hyperglycaemia (SIH), and post-infarct LVSD. Methods: A total of 274 first STEMI patients were enrolled in this cross-sectional study. Transthoracic echocardiography was performed within 48 h after admission and at 6 months after discharge to obtain left ventricular ejection fraction (LVEF). The change in LVEF was calculated as LVEF at 6 months after discharge minus baseline LVEF. Additionally, post-infarct LVSD was defined as LVEF ≤ 50%. Most importantly, glycaemic gap was calculated as admission blood glucose (ABG) minus the estimated average glucose over the previous 3 months. Results: In patients without diabetes mellitus (DM), multivariate linear regression analysis revealed that both glycaemic gap (Beta = − 1.214, 95% CI − 1.886 to − 0.541, p < 0.001) and ABG (Beta = − 1.124, 95% CI − 1.795 to − 0.453, p = 0.001) were associated with change in LVEF. In DM patients, only glycaemic gap was still associated with change in LVEF, although this association was not observed in univariate linear regression analysis. Regarding the association between SIH and post-infarct LVSD, multivariate logistic regression analysis revealed that both glycaemic gap (OR = 1.490, 95% CI 1.043 to 2.129, p = 0.028) and ABG (OR = 1.600, 95% CI 1.148 to 2.229, p = 0.005) were associated with an increased risk of having post-infarct LVSD in non-DM patients. However, after multivariate adjustment in DM patients, only glycaemic gap (OR = 1.399, 95% CI 1.021 to 1.919, p = 0.037) remained associated with an increased risk of having post-infarct LVSD. Furthermore, the predictive value of glycaemic gap for postinfarct LVSD was not inferior to ABG in non-DM patients (p = 0.499), and only glycaemic gap, instead of ABG, could significantly predict post-infarct LVSD in DM patients (AUC = 0.688, 95% CI 0.591 to 0.774, p = 0.002). Conclusions: Glycaemic gap was strongly associated with a change in LVEF and an increased risk of having postinfarct LVSD in patients following STEMI. In STEMI patients with DM, glycaemic gap could provide more valuable information than ABG in identifying patients at high risk of developing post-infarct LVSD.

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“…The previous work had indicated that SHR could be used as a strong predictor of poor clinical outcome after mechanical thrombectomy for AIS patients [6]. There have also been studies highlighting that SHR could predict the 3-month clinical outcome of patients following thrombolytic therapy with r-tPA [7].…”

Section: Discussionmentioning

confidence: 99%

“…SHR was more intuitive in responding to stress hyperglycemia intensity than GAR and it emphasized the essentiality of glucose changes. According to the reports, SHR was associated with the poor function outcome following mechanical thrombectomy in AIS [6]. Meanwhile, the latest article demonstrated that SHR was associated with poor functional outcome in AIS patients after 3-month intravenous thrombolysis, which was the rst one concerning whether SHR could predict the clinical outcome following thrombolytic therapy with r-tPA for AIS patients [7].…”

Section: Introductionmentioning

confidence: 99%

Effects of Stress Hyperglycemia Ratio on 1-Year Clinical Outcome after Thrombolytic Therapy for Acute Ischemic Stroke

Yang¹,

Ren²,

Huang³

et al. 2020

Preprint

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BackgroundStress hyperglycemia manifests as transient hyperglycemia in the context of illness with or without known diabetes, which may cause poor clinical outcome in acute ischemic stroke (AIS) patients. The present study intended to evaluate the association between stress hyperglycemia ratio (SHR) and 1-year clinical outcome after treatment with recombinant tissue plasminogen activator (r-tPA) for AIS patients and compare the predictive effect of fasting glucose concentration, glycosylated hemoglobin (HbA1c) and SHR. MethodsData from 205 AIS patients following thrombolytic therapy with r-tPA in the Third Affiliated Hospital of Wenzhou Medical University from Apr. 2016 to Apr. 2019 were retrospectively reviewed. We grouped AIS patients according to SHR tertiles to contrast the 1-year clinical outcome. Multivariate regression analysis was carried to further analyze the association between SHR and AIS prognosis. Moreover, the receiver operating characteristics (ROC) curve analysis was used for the purpose of comparing the prognostic effects of fasting glucose concentration, HbA1c and SHR on AIS patients. ResultsSHR was an independent predictor for 1-year poor outcome (OR 1.447; 95% CI, 1.124-1.864, p = 0.004) but not the mortality of AIS patients. Restricted cubic spline regression showed a linear relationship between SHR and the odds of poor outcome. Furthermore, SHR is a fair predictor to predict 1-year poor outcome. The cut-off value of SHR levels was 0.79 with 71.0% sensitivity and 72.0 % specificity. ConclusionsThe increased SHR was strongly associated with 1-year poor outcome following thrombolytic therapy with r-tPA. Meanwhile, SHR had higher predictive value for prognosis of AIS patients than fasting glucose concentration and HbA1c. Trial registrationRetrospectively registered

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High Stress Hyperglycemia Ratio Predicts Poor Outcome after Mechanical Thrombectomy for Ischemic Stroke

Cited by 52 publications

References 27 publications

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

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

Augmented glycaemic gap is a marker for an increased risk of post-infarct left ventricular systolic dysfunction

Effects of Stress Hyperglycemia Ratio on 1-Year Clinical Outcome after Thrombolytic Therapy for Acute Ischemic Stroke

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High Stress Hyperglycemia Ratio Predicts Poor Outcome after Mechanical Thrombectomy for Ischemic Stroke

Cited by 52 publications

References 27 publications

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

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

Augmented glycaemic gap is a marker for an increased risk of post-infarct left ventricular systolic dysfunction

Effects of Stress Hyperglycemia&nbsp;Ratio on 1-Year&nbsp;Clinical Outcome after Thrombolytic Therapy for Acute Ischemic Stroke

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Effects of Stress Hyperglycemia Ratio on 1-Year Clinical Outcome after Thrombolytic Therapy for Acute Ischemic Stroke