A comparison of the stress hyperglycemia ratio, glycemic gap, and glucose to assess the impact of stress‐induced hyperglycemia on ischemic stroke outcome

Roberts, Gregory; Sires, James D.; Chen, Angela; Thynne, Tilenka; Sullivan, Cheyne; Quinn, Stephen; Chen, Won Sun; Meyer, Emily J.

doi:10.1111/1753-0407.13223

“…Cerebral hemorrhage and surgery can cause stress response, with stress hyperglycemia as one of the main manifestations of stress hyperglycemia, but its mechanism is still unclear. Previous studies have shown that the disorder of neuroendocrine-humoral regulation system, abnormal secretion of various antiregulatory hormones, and disorder of blood glucose regulation-related hormones are one of the important mechanisms of stress hyperglycemia [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Influence of Optimal Management of Hyperglycemia and Intensive Nursing on Blood Glucose Control Level and Complications in Patients with Postoperative Cerebral Hemorrhage

Sun

¹

,

Sun

²

,

Su

³

2022

Computational and Mathematical Methods in Medicine

View full text Add to dashboard Cite

Background. Cerebral hemorrhage, also known as hemorrhagic stroke, is a common clinical cerebrovascular disease, accounting for about 10%-30% of stroke, with high morbidity and mortality. Objective. To observe the effect of optimal management of hyperglycemia and intensive nursing on blood glucose control level and complications in patients with postoperative cerebral hemorrhage. Methods. One hundred and eight patients with postoperative cerebral hemorrhage comorbid with stress hyperglycemia admitted to our neurosurgery department from February 2019 to February 2022 were selected and divided into a general group of 54 cases and an optimized group of 54 cases by simple random method. The general group was managed with conventional care, while the optimized group developed optimized management of hyperglycemia for intensive care. The indexes related to blood glucose control, electrolytes, National Institutes of Health Stroke Scale (NIHSS) scores, Barthel Index (BI) scores, and time to achieve blood glucose standard, insulin pumping time, patient satisfaction, and prognosis were compared between the two groups. Results. Before intervention, there was no statistical significance in the comparison of blood glucose control-related indicators and electrolytes between the two groups ( P > 0.05 ). After 7 d and 14 d of intervention, the fasting blood glucose and 2 h postprandial blood glucose in the two groups were lower than before, while K+ and Na+ were higher than before ( P < 0.05 ). The blood glucose indexes at the same time point in the optimized group were found to be lower than those in the general group by statistical analysis, but electrolytes were not statistically significant when compared with the general group ( P > 0.05 ). In the optimized group, the time to achieve blood glucose standard ( 6.59 ± 1.94 ) d and insulin pumping time ( 7.14 ± 1.89 ) d were shorter than those in the general group [( 7.48 ± 2.12 ) d and ( 8.58 ± 2.14 ) d], insulin dosage ( 748.85 ± 63.61 ) U was less than that in the general group ( 923.54 ± 84.14 ) U, and the incidence of hypoglycemia (3.70%) was lower than that in the general group (16.67%), and the satisfaction rate (92.59%) was higher than that of the general group (77.78%), which was statistically significant ( P < 0.05 ). Before intervention, there was no significant difference in NIHSS score and BI score between the two groups ( P > 0.05 ). After 7 d and 14 d of intervention, the NIHSS scores of the two groups were lower than before, while the BI scores were higher than before, and the NIHSS scores of the optimized group at the same time point were all lower than those of the general group, and the BI scores were higher than those of the general group ( P < 0.05 ). The incidence of pulmonary infection (11.11%) and rebleeding (7.41%) in the optimized group were lower than those in the general group (25.93% and 22.22%), while deep vein thrombosis, multiple organ dysfunction syndrome (MODS), and death within 28 d was not statistically significant when compared with the general group ( P > 0.05 ). Conclusion. Optimal management of hyperglycemia and intensive nursing can effectively control the blood sugar level of patients after cerebral hemorrhage, reducing insulin dosage, and the occurrence of hypoglycemia, pulmonary infection, and rebleeding.

show abstract

“…Yang et al found that both SHR and glycaemic gap were useful in evaluating the ischaemic stroke severity and prognosis [34]. However, Roberts et al discovered that SHR instead of glycaemic gap was associated with outcomes in ischaemic stroke patients [35]. We found that both the acute/chronic glycaemic ratio and ∆ A-C were significant predictors of AKI, and the risk of AKI was four times higher for every 0.1 increasement in the acute/chronic glycaemic ratio.…”

Section: Discussionmentioning

confidence: 57%

Construction of a Glycaemia-Based Signature for Predicting Acute Kidney Injury in Ischaemic Stroke Patients after Endovascular Treatment

Liu

¹

,

Li

²

,

Xu

³

et al. 2022

JCM

View full text Add to dashboard Cite

Background: Hyperglycaemia is thought to be connected to worse functional outcomes after ischaemic stroke. However, the association between hyperglycaemia and acute kidney injury (AKI) after endovascular treatment (EVT) remains elusive. The purpose of this study was to investigate the influence of glycaemic on AKI after EVT. Methods: We retrospectively collected the clinical information of patients who underwent EVT from April 2015 to August 2021. Blood glucose after EVT was recorded as acute glycaemia. Chronic glucose levels were estimated by glycosylated haemoglobin (HbA1c) using the following formula: chronic glucose levels (mg/dL) = 28.7 × HbA1c (%) − 46.7. AKI was defined as an increase in maximum serum creatinine to ≥1.5 baseline. We evaluated the association of AKI with blood glucose. A nomogram was established to predict the risk of AKI, and its diagnostic efficiency was determined by decision curve analysis. Results: We enrolled 717 acute ischaemic stroke patients who underwent EVT. Of them, 205 (28.6%) experienced AKI. Acute glycaemia (OR: 1.007, 95% CI: 1.003–1.011, p < 0.001), the acute/chronic glycaemic ratio (OR: 4.455, 95% CI: 2.237–8.871, p < 0.001) and the difference between acute and chronic glycaemia (ΔA-C) (OR: 1.008, 95% CI: 1.004–1.013, p < 0.001) were associated with the incidence of AKI. Additionally, age, atrial fibrillation, ASITN/SIR collateral grading, postoperative mTICI scale, and admission NIHSS were also significantly correlated with AKI. We then created a glycaemia-based nomogram, and its concordance index was 0.743. The net benefit of the nomogram was further confirmed by decision curve analysis. Conclusions: The glycaemia-based nomogram may be used to predict AKI in ischaemic stroke patients receiving EVT.

show abstract

“…However, our findings showed that the RPG was not associated with this outcome, while the SHR was independently associated with a higher degree of CED, 90-day poor functional outcome, and 90-day death, and the predictive value of the SHR (as a continuous variable) for moderate-to-severe CED and 90-day poor functional outcome, indicated by the AUC, was better than that of the RPG or FPG. Previous literature showed that the SHR was more strongly associated with outcomes than glucose levels: A previous study showed that stress hyperglycemia was associated with poor outcomes of acute cerebral infarction, such as stroke exacerbation, inpatient mortality, or functional deficits at discharge, while glucose levels were not ( Roberts et al, 2021 ). In another study, glucose levels were not associated with critical illness (in-hospital death or critical care) in multivariate logistic regression analysis, while the SHR maintained a significant association.…”

Section: Discussionmentioning

confidence: 99%

The stress hyperglycemia ratio is associated with the development of cerebral edema and poor functional outcome in patients with acute cerebral infarction

Deng

¹

,

Wu

²

,

Liu

³

et al. 2022

Front. Aging Neurosci.

View full text Add to dashboard Cite

Background and purposeAbsolute hyperglycemia at admission has been shown to be associated with the development of cerebral edema (CED) after acute cerebral infarction. Stress hyperglycemia is a more objective reflection of hyperglycemic state than absolute hyperglycemia. However, studies on the associations between stress hyperglycemia and CED are limited. We aimed to explore the associations of stress hyperglycemia, measured by stress hyperglycemia ratio (SHR), with the development of CED and poor functional outcome of acute cerebral infarction.MethodsPatients with acute middle artery cerebral infarction admitted to the Department of Neurology, West China Hospital of Sichuan University, within 24 h of symptom onset from January 2017 to March 2021 were included. Stress hyperglycemia was assessed by the SHR: admission fasting plasma glucose (FPG)/hemoglobin A1c (HbA1c). The primary outcome was the degree of CED evaluated on brain image. The secondary outcomes were moderate-to-severe CED, poor functional outcome (modified Rankin Scale score > 2), and death at 90 days. The associations between the SHR and outcomes were assessed with multivariate logistic regression analyses. We further compared the predictive value of the SHR, admission random plasma glucose (RPG), and admission FPG for outcomes in the training dataset and validation dataset.Results638 patients were enrolled. Each 0.1-point increase in the SHR was independently associated with a 1.31-fold increased risk of a higher degree of CED [odds ratio (OR): 1.31 (95% confidence interval (CI): 1.20–1.42), P < 0.001]. The SHR was independently associated with moderate-to-severe CED [per 0.1-point increase: OR: 1.39 (95% CI: 1.24–1.57), P < 0.001], poor functional outcome [per 0.1-point increase: OR: 1.25 (95% CI: 1.12–1.40), P < 0.001], and death [per 0.1-point increase: OR: 1.13 (95% CI: 1.03–1.25), P < 0.05]. The predictive value of the SHR (as a continuous variable), exhibited by the area under the curve in receiver operating characteristic analysis, was higher than that of the RPG and FPG for moderate-to-severe CED and poor functional outcome (P < 0.05).ConclusionThe SHR is independently associated with the severity of CED, poor functional outcome, and death after acute cerebral infarction, and the SHR (as a continuous variable) has a better predictive value for moderate-to-severe CED and poor functional outcome than the RPG and FPG.

show abstract

A comparison of the stress hyperglycemia ratio, glycemic gap, and glucose to assess the impact of stress‐induced hyperglycemia on ischemic stroke outcome

Cited by 36 publications

References 22 publications

Influence of Optimal Management of Hyperglycemia and Intensive Nursing on Blood Glucose Control Level and Complications in Patients with Postoperative Cerebral Hemorrhage

Influence of Optimal Management of Hyperglycemia and Intensive Nursing on Blood Glucose Control Level and Complications in Patients with Postoperative Cerebral Hemorrhage

Construction of a Glycaemia-Based Signature for Predicting Acute Kidney Injury in Ischaemic Stroke Patients after Endovascular Treatment

The stress hyperglycemia ratio is associated with the development of cerebral edema and poor functional outcome in patients with acute cerebral infarction

Contact Info

Product

Resources

About