Prognostic significance of diabetes and stress hyperglycemia in acute stroke patients

Abstract

Background Hyperglycemic non-diabetic stroke patients have a worse prognosis than both normoglycemic and diabetic patients. Aim of this study was to assess whether hyperglycemia is an aggravating factor or just an epiphenomenon of most severe strokes. Methods In this retrospective study, 1219 ischemic or hemorrhagic stroke patients (73.7 ± 13.1 years) were divided into 4 groups: 0 = non-hyperglycemic non-diabetic, 1 = hyperglycemic non-diabetic, 2 = non-hyperglycemic diabetic and 3 = hyperglycemic diabetic. Hyperglycemia was defined as fasting blood glucose ≥ 126 mg/dl (≥ 7 mmol/l) measured the morning after admission, while the diagnosis of diabetes was based on a history of diabetes mellitus or on a glycated hemoglobin ≥ 6.5% (≥ 48 mmol/mol), independently of blood glucose levels. All diabetic patients, except 3, had Type 2 diabetes. The 4 groups were compared according to clinical history, stroke severity indicators, acute phase markers and main short term stroke outcomes (modified Rankin scale ≥ 3, death, cerebral edema, hemorrhagic transformation of ischemic lesions, fever, oxygen administration, pneumonia, sepsis, urinary infection and heart failure). Results Group 1 patients had more severe strokes, with larger cerebral lesions and higher inflammatory markers, compared to the other groups. They also had a high prevalence of atrial fibrillation, prediabetes, previous stroke and previous arterial revascularizations. In this group, the highest frequencies of cerebral edema, hemorrhagic transformation, pneumonia and oxygen administration were obtained. The prevalence of dependency at discharge and in-hospital mortality were equally high in Group 1 and Group 3. However, in multivariate analyses including stroke severity, cerebral lesion diameter, leukocytes and C-reactive protein, Group 1 was only independently associated with hemorrhagic transformation (OR 2.01, 95% CI 0.99–4.07), while Group 3 was independently associated with mortality (OR 2.19, 95% CI 1.32–3.64) and disability (OR 1.70, 95% CI 1.01–2.88). Conclusions Hyperglycemic non-diabetic stroke patients had a worse prognosis than non-hyperglycemic or diabetic patients, but this group was not independently associated with mortality or disability when size, severity and inflammatory component of the stroke were accounted for.

Association between Stress Hyperglycemia Ratio and Functional Outcomes in Patients with Acute Ischemic Stroke

“…The findings showed consistent effects of SHR on 90-day poor functional outcomes across subgroups, and the interaction analysis also showed no heterogeneity among patients with different baseline characteristics. This study found the association between non-diabetic patients and both SHR and 90-day poor functional outcomes in diabetic patients, but the risk was significantly higher in non-diabetic patients [OR: 6.55 (2.98,14.41) vs OR: 3.06 (1.28.7.30)], and the previous findings were consistent 18 . The findings of Merlino et al 19 showed that elevated SHR was associated with poor clinical prognosis at 90 d after onset, but it is worth noting that the findings were only applicable to non-diabetic patients with AIS.…”

Incidence of Stress-Induced Hyperglycemia in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

“…Type 2 diabetes patients have at least a 2-fold increase in the risk of developing AIS, and hyperglycemia in AIS patients is associated with high disability and mortality rates [ 40 ].…”

Association of Prediabetes and Recurrent Stroke in Atrial Fibrillation Patients: A Population-Based Analysis of Hospitalizations and Outcomes

“…Recently, it has even been implicated as a risk factor for new-onset atrial fibrillation [11]. Even looking at the prognosis, nondiabetic patients with hyperglycemia have a worse stroke prognosis [12]. In terms of organ damage, two out of three patients with coronary artery disease exhibit compromised glucose metabolism [13].…”