The initial glycemic variability is associated with early neurological deterioration in diabetic patients with acute ischemic stroke

Hui, Jiaojie; Zhang, Jianping; Mao, Xuqiang; Li, Zaiwang; Li, Xinxin; Wang, Fengyun; Wang, Tao; Yuan, Qingfang; Wang, Sunwei; Pu, Mengjia; Xi, Guangjun

doi:10.1007/s10072-018-3463-6

Cited by 33 publications

(33 citation statements)

References 32 publications

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“…A large number of studies have confirmed that END is an independent risk factor for poor prognosis in stroke patients (Hui et al., 2018; Simonsen et al., 2016; You et al., 2019). Consequently, predictive factors for END are also of great interest.…”

Section: Discussionmentioning

confidence: 94%

Early neurological deterioration in cardiogenic cerebral embolism due to nonvalvular atrial fibrillation: Predisposing factors and clinical implications

Liu

2020

Brain and Behavior

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Purpose The aim of the study was to investigate factors which may predispose patients to early neurological deterioration (END) and explore peripheral biomarkers for the prediction of END in cardiogenic cerebral embolism (CCE) patients. Methods Patients diagnosed with CCE within 24 hr of onset between January 2017 and January 2019 were included in this study. END was defined as an increase of ≥2 on the National Institutes of Health Stroke Scale (NIHSS) or the emergence of new neurological symptoms within 3 days of admission. Binary logistic regression was used to investigate the factors associated with END. Receiver operating characteristic (ROC) curves were then generated to determine the predictive value of the potential biomarkers and the optimal cutoff values. Results Of the 129 (male, 55.81%; mean age 71.85 ± 11.99 years) CCE patients, 55 patients with END were identified. Hemorrhage transformation (HT), coronary heart disease (CHD), diastolic blood pressure, cystatin C levels, NIHSS score, and platelet‐to‐lymphocyte ratio (PLR) at admission were independently associated with END. A peripheral cystatin C level ≥ 1.41 mg/L and a PLR ≥ 132.97 were predictive factors for END in CCE patients. The lymphocyte‐to‐monocyte ratio (LMR) was negatively independently associated with HT, and LMR < 2.31 may predict the occurrence of HT in patients with CCE. Conclusions Of the potential predisposing factors considered, increased cystatin C and PLR were associated with END within 3 days of CCE, and a decreased LMR may have predictive value for HT in CCE patients.

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Section: Discussionmentioning

confidence: 94%

Early neurological deterioration in cardiogenic cerebral embolism due to nonvalvular atrial fibrillation: Predisposing factors and clinical implications

Liu

2020

Brain and Behavior

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“…Several recent clinical studies suggested that glycemic variability could be associated with the development and severity of coronary artery disease in patients with normal glucose tolerance, prediabetes, and diabetes [23-25]. A previous study also reported that glycemic variability after stroke onset could be associated with END in diabetic patients only [26]. However, evidence investigating the different pathological mechanisms of glycemic variability between prediabetic and diabetic patients has yet to be performed.…”

Section: Discussionmentioning

confidence: 99%

Pre-Stroke Glycemic Variability Estimated by Glycated Albumin Is Associated with Early Neurological Deterioration and Poor Functional Outcome in Prediabetic Patients with Acute Ischemic Stroke

et al. 2020

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Introduction: Whether glycemic variability prior to stroke increases the risk of stroke outcomes in prediabetic patients presenting with acute ischemic stroke is still unclear. We evaluated whether pre-stroke glycemic variability, estimated by glycated albumin (GA), increased early neurological deterioration (END) and functional outcomes in prediabetic patients with acute ischemic stroke. Methods: A total of 215 acute ischemic stroke patients with prediabetes were evaluated. The primary outcome was END, defined as an incremental increase in the National Institutes of Health Stroke Scale score by ≥1 point in motor power or ≥2 points in the total score within the 7 days after admission. The secondary outcome was poor functional status defined by a modified Rankin Scale at 3 months. Higher GA (≥16.0%) was determined to reflect glycemic fluctuation prior to ischemic stroke. Results: Of the 215 prediabetic patients, 77 (35.8%) were in the higher GA group. In prediabetic patients, END occurrence and poor functional status were higher in the higher GA group than in the lower GA group. The multivariate analysis showed that a higher GA was associated with an increased risk of END occurrence and poor functional outcomes at 3 months (adjusted odds ratio [95% confidence interval], 4.58 [1.64–12.81], p = 0.004 and 2.50 [1.19–5.25], p = 0.02, respectively). Conclusion: Pre-stroke glycemic variability estimated by GA was associated with END occurrence and poor functional outcome after ischemic stroke in patients with prediabetes.

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“…In addition to hypoglycemia and hyperglycemia, glycemic variability (GV) was considered as another important component of dysglycemia (43). It was reported that GV within the initial 3 hospital days was associated with increased risk for END in diabetic patients with AIS (44). Although the mechanism for the occurrence of GV in patients with AIS is not clear, GV was strongly associated with infarct volume, severity of symptoms, and stroke outcomes (45,46).…”

Section: Association Between Hyperglycemia End and Sexmentioning

confidence: 99%

Admission Glucose Levels May Increase the Risk for Early Neurological Deterioration in Females With Acute Ischemic Stroke

Huang

Zeng³

et al. 2020

Front. Neurol.

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Background and purpose: Early neurological deterioration (END) is associated with poor outcome for patients with acute ischemic stroke (AIS). Patients with hyperglycemia have increased risk for stroke and tend to have poor outcome with and without diabetes after stroke. The present study aimed to determine if blood glucose was associated with END and if sex difference was present in the development of END in AIS patients. Methods: A total of 220 consecutive patients (both males and females) with AIS between 2012 and 2015 were screened for this retrospective study. After exclusion, 213 patients were included for analysis. Propensity-score matching was used for normalization of variables including stroke severity, time from symptom onset to treatment, and treatment methods. Results: END was present in 68 patients (31.9%). Multivariate regression analysis showed that the risk of END was significantly higher in males with AIS than in females (P < 0.001), and admission blood glucose level was independently associated with END (P < 0.001). However, subgroup analysis demonstrated that admission glucose levels were significantly associated with increased risk for END only in females, but not in males (P = 0.008). When the cutoff value of 107.1 mg/dL was used, the admission blood glucose level had a significant predictive value for END prediction with a sensitivity of 100% and a specificity of 53% in female patients. Conclusions: The data demonstrated that sex difference was present for the development of END in AIS patients with an increased risk for males. The present study also showed that admission glucose level could be an important predicting factor for END in female patients with AIS.

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The initial glycemic variability is associated with early neurological deterioration in diabetic patients with acute ischemic stroke

Cited by 33 publications

References 32 publications

Early neurological deterioration in cardiogenic cerebral embolism due to nonvalvular atrial fibrillation: Predisposing factors and clinical implications

Early neurological deterioration in cardiogenic cerebral embolism due to nonvalvular atrial fibrillation: Predisposing factors and clinical implications

Pre-Stroke Glycemic Variability Estimated by Glycated Albumin Is Associated with Early Neurological Deterioration and Poor Functional Outcome in Prediabetic Patients with Acute Ischemic Stroke

Admission Glucose Levels May Increase the Risk for Early Neurological Deterioration in Females With Acute Ischemic Stroke

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