Impact of stress hyperglycemia on outcomes in patients with large ischemic stroke

被引:2
作者
Shi, Xiaolei [1 ]
Yang, Shihai [1 ]
Guo, Changwei [1 ]
Sun, Wenzhe [1 ]
Song, Jiaxing [1 ]
Fan, Shitao [1 ]
Yang, Jie [1 ]
Yue, Chengsong [1 ]
Huang, Jiandi [1 ]
Li, Linyu [1 ]
Tian, Yan [1 ]
Ma, Jinfu [1 ]
Xu, Xu [1 ]
Wang, Zhixi [1 ]
Kong, Weilin [1 ]
Ye, Dongsheng [1 ]
Peng, Zhouzhou [1 ]
Li, Fengli [1 ]
Zi, Wenjie [1 ]
机构
[1] Army Med Univ, Xinqiao Hosp, Dept Neurol, Chongqing, Peoples R China
基金
中国国家自然科学基金;
关键词
Thrombectomy; Stroke; Intervention; Embolic; POSTSTROKE HYPERGLYCEMIA; STANDARD TREATMENT; GLUCOSE; EXACERBATION; MANAGEMENT; ACIDOSIS; INSULIN; INJURY;
D O I
10.1136/jnis-2024-021899
中图分类号
R445 [影像诊断学];
学科分类号
100207 ;
摘要
Background Clinical evidence of the potential influence of stress hyperglycemia ratio (SHR) for patients with large ischemic stroke whether or not receiving endovascular therapy is not clear.Methods This study was a subanalysis of a prospective, multicenter registry, and included 745 patients with large ischemic stroke across 38 centers in China. A total of 427 patients were included in this study, with 285 received endovascular therapy (EVT) and 142 received standard medical therapy (SMT). SHR was defined as glucose (mmol/L)/(1.59 x HbA1C)-2.59. The primary outcome was a moderate neurological outcome (modified Rankin Scale (mRS) score <= 3) at 90 days.Results A significant interaction was observed between SHR and whether received EVT (p=0.017). Among patients who received EVT (adjusted OR (aOR) 0.46; 95% CI 0.23 to 0.92; p=0.029), patients in the highest tertile of SHR were significantly less likely to achieve a moderate neurological outcome at 90 days compared with those in the lowest tertile. However, this association was not observed in patients receiving SMT (aOR 2.46; 95% CI 0.74 to 8.21; p=0.142). EVT patients with higher SHR had a significantly higher incidence of symptomatic intracranial hemorrhage compared with lower SHR (aOR 3.29; 95% CI 1.08 to 10.06; p=0.036), while such an association was not observed in the SMT group (aOR 1.52; 95% CI 0.56 to 4.12; p=0.410).Conclusions In patients with large ischemic stroke treated with EVT, SHR is associated with a reduced likelihood of achieving a moderate neurological outcome, as well as an increased risk of symptomatic intracranial hemorrhage.Trial registration number ChiCTR2100051664.
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