Stress Hyperglycemia and Outcome of Non-diabetic Patients After Acute Ischemic Stroke

Abstract

Background and Purpose: Stress hyperglycemia is relative hyperglycemia after suffering an acute illness such as stroke, even without preexisting diabetes. Our study aimed to determine the relationship between stress hyperglycemia and outcome of non-diabetic patients with acute ischemic stroke.Methods: Data were derived from the ACROSS-China (Abnormal Glucose Regulation in Patients with Acute Stroke across China) registry. Patients with ischemic stroke but without a history of diabetes mellitus were included in this analysis. Stress hyperglycemia was measured by glucose-to-glycated hemoglobin (HbA1c) ratio which was calculated by fasting plasma glucose (FPG) divided by HbA1c. We investigated the association between quartiles of glucose-to-HbA1c ratio and stroke recurrence and all-cause death at 12 months after stroke onset.Results: We included a total of 999 patients, among which there were 105 (10.9%) recurrent strokes and 76 (7.6%) deaths at 12 months. Using the lowest quartile of glucose-to-HbA1c ratio as the reference, patients with the highest quartile were associated with an increased risk of stroke recurrence [16.0 vs. 8.3%; adj.hazards ratio (HR) = 2.19, 95% confidence interval (CI): 1.26–3.83] and death (13.0 vs. 4.3%; adj.HR=2.86, 95%CI: 1.38–5.90) at 12 months after adjusted for potential covariates. We also observed that a higher level of glucose-to-HbA1c ratio was associated with an elevated risk of stroke recurrence and death.Conclusion: Stress hyperglycemia, measured by glucose-to-HbA1c ratio, was related to an elevated risk of stroke recurrence and all-cause death in patients with acute ischemic stroke but without diabetes.

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

“…Previous study showed that such relative measures controlling for background glycemia better predicted prognosis of critical illness than absolute hyperglycemia ( 6 – 8 ). We previously found that glucose/HbA1c ratio was related to all-cause death in people with acute ischemic stroke ( 9 ). In the current study, we further added evidence that glucose/HbA1c ratio could predict neurological deficit, in addition to mortality.…”

“…Recent studies demonstrated that relative hyperglycemia, defined as glucose/HbA1c ratio or admission glucose divided by estimated average glucose derived from HbA1c, might be a more reliable method to measure the degree of stress hyperglycemia and a better predictor for outcomes of acute illness than absolute hyperglycemia ( 6 – 8 ). Our recent study showed that relative hyperglycemia of glucose/HbA1c ratio was related to mortality in the ischemic stroke people without diabetes ( 9 ). However, its association with neurological functional disability is still undefined.…”

Dynamic Hyperglycemic Patterns Predict Adverse Outcomes in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy

“…Based on previous studies [ 30 , 31 , 32 ], we adopted the following definitions of vascular risk factors: (1) previous transient ischemic attack/stroke was defined if the patient had a history of ischemic (transient attack or stroke) or hemorrhagic cerebrovascular disease; (2) the presence of cardiovascular disease was based on the history of previous ischemic heart disease and/or revascularization treatment using percutaneous coronary intervention/coronary artery bypass grafting; (3) atrial fibrillation was defined if the patient had past medical history of atrial fibrillation that had been confirmed in medical records; (4) high blood pressure was defined as the history of hypertension and/or use of antihypertensive medication; (5) a history of diabetes mellitus that had been confirmed in medical records and/or use of insulin/oral hypoglycemic agents were considered for defining diabetes; (6) a presence of hypercholesterolemia was based on the use of lipid-lowering medications; (7) information on active tobacco use was used for defining patient as a current smoker.…”

Uncoupling Protein 2 Deficiency Enhances NLRP3 Inflammasome Activation Following Hyperglycemia-Induced Exacerbation of Cerebral Ischemia and Reperfusion Damage In Vitro and In Vivo

“…Ischemic stroke is identified as one of the major causes of disability and mortality worldwide. Hyperglycemia is an important independent risk factor for ischemic stroke and induces the occurrence and development of cerebral I/R damage [ 1 , 2 ]. Previous studies have shown that the exacerbation of ROS production, promotion of neuroinflammation, and extensive programmed cell death are possible mechanisms associated with hyperglycemia-exacerbated cerebral I/R damage.…”