Large vessel occlusion stroke outcomes in diabetic vs. non-diabetic patients with acute stress hyperglycemia

Abstract

ObjectiveThis study assesses whether stress-induced hyperglycemia is a predictor of poor outcome at 3 months for patients with acute ischemic stroke (AIS) treated by endovascular treatment (EVT) and impacted by their previous blood glucose status.MethodsThis retrospective study collected data from 576 patients with AIS due to large vessel occlusion (LVO) treated by EVT from March 2019 to June 2022. The sample was composed of 230 and 346 patients with and without diabetes mellitus (DM), respectively, based on their premorbid diabetic status. Prognosis was assessed with modified Rankin Scale (mRS) at 3-month after AIS. Poor prognosis was defined as mRS>2. Stress-induced hyperglycemia was assessed by fasting glucose-to-glycated hemoglobin ratio (GAR). Each group was stratified into four groups by quartiles of GAR (Q1–Q4). Binary logistic regression analysis was used to identify relationship between different GAR quartiles and clinical outcome after EVT.ResultsIn DM group, a poor prognosis was seen in 122 (53%) patients and GAR level was 1.27 ± 0.44. These variables were higher than non-DM group and the differences were statistically significant (p < 0.05, respectively). Patients with severe stress-induced hyperglycemia demonstrated greater incidence of 3-month poor prognosis (DM: Q1, 39.7%; Q2, 45.6%; Q3, 58.6%; Q4, 68.4%; p = 0.009. Non-DM: Q1, 31%; Q2, 32.6%; Q3, 42.5%; Q4, 64%; p < 0.001). However, the highest quartile of GAR was independently associated with poor prognosis at 3 months (OR 3.39, 95% CI 1.66–6.96, p = 0.001), compared to the lowest quartile in non-DM patients after logistic regression. This association was not observed from DM patients.ConclusionThe outcome of patients with acute LVO stroke treated with EVT appears to be influenced by premorbid diabetes status. However, the poor prognosis at 3-month in patients with DM is not independently correlated with stress-induced hyperglycemia. This could be due to the long-term damage of persistent hyperglycemia and diabetic patients’ adaptive response to stress following acute ischemic damage to the brain.

Stress hyperglycemia and risk of adverse outcomes in patients with acute ischemic stroke: a systematic review and dose–response meta–analysis of cohort studies

“…These mixed findings underline the complex relationship between diabetes and post-AIS outcomes. The initial 90 days post-AIS are vital for diabetic patients, aligning with previous studies (35,43,47,48) that they may face more severe AIS effects or complications during this period. Hence, immediate optimal glycemic control post-stroke is essential.…”

“…Shi et al (52) found in their meta-analysis that blood glucose is crucial for stroke risk, with a non-linear relationship between FBG and stroke risk. As seen in Figure 3, the risk of 3-month mortality for diabetics is on par or higher than for non-diabetics, as shown by Duan et al (48) and Merlino et al (43). Yet, the 1-year mortality risk is lower for diabetics, as found by Li et al (35).…”

“…Subsequently, a manual search was conducted in the mentioned electronic databases, leading to the inclusion of six additional studies (46-51) that met the criteria for the dose-response meta-analysis. In total, 13 studies (10, 24,34,35,39,43,44,[46][47][48][49][50][51] were included in this systematic review and dose-response meta-analysis (Figure 1). These studies were published between 2019 and 2023 and involved a total of 184,179 participants (Table 1).…”

“…Among the 13 studies, 10 were conducted in China and three in Italy. Four studies (35,43,47,48) stratified the study population into diabetes and non-diabetes subgroups, with each subgroup treated as an independent study.…”

“…The summarized findings are presented in Table 2. Seven studies (10, 24,39,43,[46][47][48] provided data on 3-month poor functional outcome, and the sub-groups from three studies (43, 47,48) were treated as independent entities. Consequently, a total of 10 records were included in the final analysis.…”