Stress hyperglycemia is predictive of worse outcome in patients with acute ischemic stroke undergoing intravenous thrombolysis

Merlino, Giovanni; Smeralda, Carmelo; Gigli, Gian Luigi; Lorenzut, Simone; Pez, Sara; Surcinelli, Andrea; Marini, A; Valente, Mariarosaria

doi:10.1007/s11239-020-02252-y

Cited by 33 publications

(37 citation statements)

References 34 publications

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“…In addition, patients with a bridging therapy after intravenous thrombolysis were not excluded in some studies. Due to the similar research methods, the level of HbA1c and blood glucose in our study was similar to the study by Merlino G et al [3]. Besides, our study not only proved that SHR levels were related to the 1-year clinical outcome after thrombolysis with r-tPA, but also con rmed by ROC that the prognostic effect of SHR was better than fasting glucose and HbA1c.…”

Section: Discussionsupporting

confidence: 89%

“…The glucose-to-HbA1c ratio (GAR) has been used for assessing stress hyperglycemia in previous study. Higher risk of symptomatic intracranial hemorrhage and recurrent stroke were observed in patients with high GAR level [3,4]. Recently, a novel index introduced by Roberts et al [5] called Stress hyperglycemia ratio (SHR) was applied for assessing stress hyperglycemia.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 89%

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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“…Another study showed that the odds of stroke recurrence and all-cause death were significantly increased in non-diabetic patients affected by stress hyperglycemia, as estimated by the GAR index ( 37 ). Recently, we demonstrated an independent association between stress hyperglycemia and impaired clinical outcomes in AIS patients undergoing alteplase ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

“…Stress hyperglycemia is mediated by the hypothalamicpituitary-adrenal axis, the sympatho-adrenal system, and pro-inflammatory cytokines that cause a stress response with excessive gluconeogenesis, glycogenolysis, and insulin resistance (32). Although several studies have reported that stress hyperglycemia increases the risk of poor outcomes in AIS patients (33)(34)(35)(36), very few studies have investigated the impact of stress hyperglycemia in stroke patients treated with recanalization therapy (20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

“…Persistent hyperglycemia might impair outcomes as a marker of either diabetes mellitus or activation of the hypothalamicpituitary-adrenal axis, that is, stress hyperglycemia. Although diabetes is a widely recognized predictor of stroke (19), little data are available on the possible detrimental effects of stress hyperglycemia in AIS patients undergoing recanalization therapy (20)(21)(22). In particular, only two recent Chinese studies reported that stress hyperglycemia was a strong predictor of poor clinical outcomes and mortality after MT (21,22).…”

Section: Introductionmentioning

confidence: 99%

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Stress Hyperglycemia in Patients With Acute Ischemic Stroke Due to Large Vessel Occlusion Undergoing Mechanical Thrombectomy

et al. 2021

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Stress hyperglycemia may impair outcomes in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT). The glucose-to-glycated hemoglobin ratio (GAR) was used to measure stress hyperglycemia. Data from our database of consecutive patients admitted to the Udine University Hospital with AIS who were treated with MT between January 2015 and December 2020 were retrospectively analyzed. We included 204 patients in the study and stratified them into four groups according to the quartiles of GAR (Q1–Q4). The higher the GAR index, the more severe the stress hyperglycemia was considered. Patients with more severe stress hyperglycemia showed a higher prevalence of 3-month poor outcome (Q1, 53.1%; Q2, 40.4%; Q3, 63.5%; Q4, 82.4%; p = 0.001), 3-month mortality (Q1, 14.3%; Q2, 11.5%; Q3, 15.4%; Q4, 31.4%; p = 0.001), and symptomatic intracranial hemorrhage (Q1, 2%; Q2, 7.7%; Q3, 7.7%; Q4, 25.4%; p = 0.001). After controlling for several confounders, severe stress hyperglycemia remained a significant predictor of 3-month poor outcome (OR 4.52, 95% CI 1.4–14.62, p = 0.012), 3-month mortality (OR 3.55, 95% CI 1.02–12.29, p = 0.046), and symptomatic intracranial hemorrhage (OR 6.89, 95% CI 1.87–25.36, p = 0.004). In summary, stress hyperglycemia, as measured by the GAR index, is associated with a detrimental effect in patients with AIS undergoing MT.

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The association between serum glucose to potassium ratio on admission and short-term mortality in ischemic stroke patients

Zhou

et al. 2022

Sci Rep

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High serum glucose to potassium ratio (GPR) at admission is implicated for a poor outcome in acute brain injury, acute intracranial hemorrhage, and aneurysmal subarachnoid hemorrhage. However, the relationship between GPR and the outcome of ischemic stroke (IS) remains unknown. In all, 784 IS patients from a large emergency Norwegian cohort were included for secondary analysis. The exposure and outcome were GPR at baseline and all-cause mortality within 30 days after the first admission. Multivariable logistic regression analysis was performed to estimate the risk of 30-day mortality based on GPR levels. In addition, we examined whether there was a nonlinear relationship between admission GPR and 30-day mortality using two-piecewise linear regression with a smoothing function and threshold level analysis. The results of multivariable regression analysis showed that GPR at baseline was positively associated with the 30-day mortality (OR 2.01, 95% CI 1.12, 3.61) after adjusting for potential confounders (age, gender, department, serum sodium, serum albumin, serum-magnesium, hypertension, heart failure, chronic renal failure, and pneumonia). When GPR was translated to a categorical variable, the ORs and 95% CIs in the tertiles 2 to 3 versus the tertile 1 were 1.24 (0.60, 2.56) and 2.15 (1.09, 4.24), respectively (P for trend = 0.0188). Moreover, the results of the two-piecewise linear regression and curve fitting revealed a linear relationship between GPR and 30-day mortality. In IS patients, GPR is positively correlated with 30-day mortality, and the relationship between them is linear. The GPR at admission may be a promising predictor for the short-term outcome in IS patients.

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Stress hyperglycemia is predictive of worse outcome in patients with acute ischemic stroke undergoing intravenous thrombolysis

Cited by 33 publications

References 34 publications

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

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

Stress Hyperglycemia in Patients With Acute Ischemic Stroke Due to Large Vessel Occlusion Undergoing Mechanical Thrombectomy

The association between serum glucose to potassium ratio on admission and short-term mortality in ischemic stroke patients

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Stress hyperglycemia is predictive of worse outcome in patients with acute ischemic stroke undergoing intravenous thrombolysis

Cited by 33 publications

References 34 publications

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

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

Stress Hyperglycemia in Patients With Acute Ischemic Stroke Due to Large Vessel Occlusion Undergoing Mechanical Thrombectomy

The association between serum glucose to potassium ratio on admission and short-term mortality in ischemic stroke patients

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

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