Hyperglycemia is associated with poor in-hospital outcome in elderly patients with acute ischemic stroke

Zhao, Lei; Wang, Li; Lu, Mei-Hua; Hu, Wei; Xiu, Shuangling

doi:10.1097/md.0000000000016723

Cited by 14 publications

(11 citation statements)

References 35 publications

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“…Tight glycemic control in the management of acute ischemic stroke remains controversial due to the hypoglycemic consequences [32]. Despite the debate, the control of stress hyperglycemia and having it return to the normal range is of benefit to ischemic stroke subjects, as seen in experimental studies [4,33,34]. The homeostatic regulation of circulating glucose levels is strictly counterbalanced by gluconeogenesis, glycogenolysis, and glucose uptake as it occurred in the liver, adipose tissues, skeletal muscles, and kidney.…”

Section: Discussionmentioning

confidence: 99%

Effects of β-Adrenergic Blockade on Metabolic and Inflammatory Responses in a Rat Model of Ischemic Stroke

Lin

Wang

Chang

et al. 2020

Cells

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Ischemic stroke provokes an inflammatory response concurrent with both sympathetic nervous system activation and hyperglycemia. Currently, their crosstalk and consequences in stroke outcomes are of clinical attraction. We have provided experimental evidence showing the suppressive effects of the nonselective β-adrenoreceptor antagonist propranolol on hyperglycemia, inflammation, and brain injury in a rat model experiencing cerebral ischemia. Pretreatment with propranolol protected against postischemic brain infarction, edema, and apoptosis. The neuroprotection caused by propranolol was accompanied by a reduction in fasting glucose, fasting insulin, glucose tolerance impairment, plasma C-reactive protein, plasma free fatty acids, plasma corticosterone, brain oxidative stress, and brain inflammation. Pretreatment with insulin alleviated—while glucose augmented—postischemic brain injury and inflammation. Additionally, the impairment of insulin signaling in the gastrocnemius muscles was noted in rats with cerebral ischemia, with propranolol improving the impairment by reducing oxidative stress and tumor necrosis factor-α signaling. The anti-inflammatory effects of propranolol were further demonstrated in isoproterenol-stimulated BV2 and RAW264.7 cells through its ability to decrease cytokine production. Despite their potential benefits, stroke-associated hyperglycemia and inflammation are commonly linked with harmful consequences. Our findings provide new insight into the anti-inflammatory, neuroprotective, and hypoglycemic mechanisms of propranolol in combating neurodegenerative diseases, such as stroke.

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Section: Discussionmentioning

confidence: 99%

Effects of β-Adrenergic Blockade on Metabolic and Inflammatory Responses in a Rat Model of Ischemic Stroke

Lin

Wang

Chang

et al. 2020

Cells

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“…9 10 23 24 Masrur et al 9 studied 1408 patients who had AIS, who received intravenous thrombolysis and showed that high blood glucose levels at the time of admission increased the risk of unfavourable functional outcomes and death. Snarska et al 10 and Zhao et al 25 reported that a high blood glucose level in patients who had AIS at the time of admission was significantly associated with an unfavourable functional outcome and risk of in-hospital death. Moreover, several previous studies involving patients who had AIS without DM showed that high blood glucose levels were also closely related to unfavourable functional outcomes and risk of death.…”

Section: Open Accessmentioning

confidence: 99%

Association between fasting blood glucose and outcomes and mortality in acute ischaemic stroke patients with diabetes mellitus: a retrospective observational study in Wuhan, China

et al. 2020

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ObjectiveTo evaluate the predictive value of fasting blood glucose (FBG) on unfavourable outcomes and mortality in diabetes mellitus (DM) patients after acute ischaemic stroke (AIS).Study designA hospital-based observational cohort study was conducted. Clinical data, including sex, age, body mass index, vascular risk factors and systolic/diastolic blood pressure, were routinely collected. National Institutes of Health Stroke Scale score was used to assess stroke severity on admission. FBG was determined on the first day after fasting for at least 8 hours. The modified Rankin Scale was used to assess functional outcome at 90 days: 3–6, unfavourable outcome and 6, death.SettingRenmin Hospital of Wuhan University, Wuhan, China.ParticipantsPatients who had AIS with DM, who were consecutively admitted within 24 hours of onset from January 2018 to June 2019.ResultsFor the 568 patients, the median age was 65 years (IQR, 55–74 years). There were 377 (66.4%) men. The median FBG values were 7.37 mmol/L (IQR, 5.99–10.10 mmol/L), and the median glycated haemoglobin (HbA1c) values were 6.6 (IQR, 5.8–8.3). Multivariable logistic and Cox regression analysis of confounding factors showed that FBG at the time of admission was an independent predictor of unfavourable outcome (OR, 1.25 (1.14–1.37); p<0.0001) and mortality (HR, 1.10 (1.03–1.15); p<0.05) at 90 days after onset. Time to death was analysed by Kaplan-Meier curves based on FBG quartiles. The risk of death in the two highest quartile groups (FBG, 7.38–10.10 mmol/L; FBG, ≥10.11 mmol/L) was significantly higher than that in the two lowest quartile groups (FBG, ≤6.00 mmol/L; FBG, 6.01–7.37 mmol/L; p<0.0001).ConclusionsHigher FBG levels are associated with unfavourable outcomes and mortality in Chinese patients who had AIS with DM. Our data contribute to the knowledge regarding the relationship between FBG and prognosis in patients with DM who had AIS.

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“…While the clinical and radiological features at the time of presentation are of great prognostic importance, other paraclinical features are also related to the severity of stroke and the course of the disease. Parameters such as mean blood pressure and mean blood glucose level, the nature of the antihypertensive drug used should also be considered 34‐36 . In light of all this information, it can be ensured that stroke patients are evaluated in all aspects, and perhaps a decision‐making model with all parameters can be created as a result of these studies.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the relation between the neutrophil to lymphocyte ratio and severity of ischemic stroke in a large cohort

et al. 2021

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Aim of study The NLR is a simple and inexpensive parameter that is useful as a marker of subclinical inflammation. The purpose of this study was to investigate the clinical characteristics of patients diagnosed with acute cerebral ischemia at the time of initial evaluation in the emergency department. Patients and methods The study was designed as a multicentre cross‐sectional study of acute ischemic stroke patients. Neurological evaluations were assessed using the NIHSS and mRS. Evaluations included the results of patients’ laboratory tests performed at the time of presentation to the emergency department. Results Seven hundred and thirty‐five ischemic stroke patients were included in the study. Stroke cases assessed by the mRS as mild or severe showed significant differences with respect to age, leukocyte counts, neutrophil counts, NLR, LDL cholesterol values, and serum glucose values (P = .001). When analysed using NIHSS, lymphocyte levels were significantly higher in very severe stroke cases compared with mild, moderate, and severe cases. NLR was also significantly higher in very severe stroke cases and severe stroke cases as compared with the mild and moderate stroke groups. Neurological evaluations assessed using the mRS showed a mild positive correlation with neutrophil and leukocyte count and a weak correlation with the NLR. Conclusion The NLR exhibited a significant correlation with the results of the mRS and NIHSS. The NLR measured in the very early period was also significantly associated with clinical condition. These results suggest that high NLR values may be a marker of stroke’ severity.

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Hyperglycemia is associated with poor in-hospital outcome in elderly patients with acute ischemic stroke

Abstract: Supplemental Digital Content is available in the text

Cited by 14 publications

References 35 publications

Effects of β-Adrenergic Blockade on Metabolic and Inflammatory Responses in a Rat Model of Ischemic Stroke

Effects of β-Adrenergic Blockade on Metabolic and Inflammatory Responses in a Rat Model of Ischemic Stroke

Association between fasting blood glucose and outcomes and mortality in acute ischaemic stroke patients with diabetes mellitus: a retrospective observational study in Wuhan, China

Assessment of the relation between the neutrophil to lymphocyte ratio and severity of ischemic stroke in a large cohort

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