Association between Elevated Hemoglobin A1c Levels and the Outcomes of Patients with Small-Artery Occlusion: A Hospital-Based Study

Abstract

IntroductionAbnormal glucose metabolism is an independent risk factor for poor outcome following acute ischemic stroke. However, the relationship between initial hemoglobin A1c level and functional outcome (defined by modified Rankin Scale scores) following small-artery occlusion, a subtype of ischemic stroke, is unknown. The aim of the present study was to evaluate this association among patients diagnosed with small-artery occlusion.Materials and MethodsData on 793 patients diagnosed with small-artery occlusion from October 25, 2012 to June 30, 2015 were collected from the stroke registry of the Department of Neurorehabilitation of HuanHu Hospital. Hemoglobin A1c values at admission were classified into three groups according to tertiles (<5.9,5.9to<6.7, and≥6.7). We used receiver operating characteristics curves to investigate the predictive value of hemoglobin A1c and examined the relationship between hemoglobin A1c levels at admission and modified Rankin Scale scores using univariate and multivariate analyses.ResultsThe area under the curve was 0.570 (95%CI, 0.509–0.631; P = 0.023). Patients in the highest HbA1c stratification (≥6.7) had a significantly higher risk of an unfavorable outcome than patients in the lowest stratification (<5.9; adjusted odds ratio, 2.099; 95%CI, 1.160–3.798; P = 0.014). However, a significant association was not seen in the middle stratification (5.9 to <6.7; P = 0.115).ConclusionsElevated hemoglobin A1c level on admission was adversely associated with functional outcomes 3 months after stroke onset among patients presenting with small-artery occlusion.

Stroke outcome prediction: what do we know and where are we going?

“…These findings confirm and expand the existing body of knowledge whereby abnormal glucose metabolism can be a risk factor for unfavorable outcome following acute cerebral ischaemia . Looking at the underlying pathophysiology, it is plausible that more than one mechanism can play a role.…”

“…Similarly, the suboptimal pre‐stroke glycemic status was an independent predictor of poor functional outcome at hospital discharge, regardless of baseline glycemia, stroke severity and blood pressure levels. Noteworthy, HbA1c can reflect the long‐term glycemic status without being influenced by stress‐induced hyperglycemia, reinstitution of oral feeding or administration of glucose‐containing fluids .…”

“…Stroke outcome probably reflects and depends on clinical setting and patient demographics as well as on a multitude of variables associated with metabolism, cerebral perfusion, inflammatory response and drug actions . All these variables may act at the site of cerebral damage and/or at systemic level and influence recanalization success, neuro‐vascular recovery, secondary‐induced brain injury and systemic complications.…”

Hemoglobin A1c predicts hemorrhagic transformation and poor outcomes after acute anterior stroke

“…In this cohort, we demonstrated that HbA1c was also found to be an independent predictor of short‐term prognosis. Recent studies also indicated that pre‐stroke glycemic status was a predictive factor of 3‐month functional outcomes, and HbA1c values exceeding the target level were related to an increased risk of unfavorable recovery .…”

An Elevated High-Sensitivity C-Reactive Protein Level Is Associated with Unfavorable Functional Outcomes of Small-Artery Occlusion in Patients without Diabetes

“…Small artery occlusion (SAO), a subtype of ischemic stroke classified by the Trial of ORG10172 in Acute Stroke Treatment (TOAST), is associated with the lowest stroke severity and mortality rate among the stroke subtypes [1,2,3,4], although survivors may experience different degrees of functional impairment. Therefore, the evaluation of functional independency (measured using the modified Rankin scale [mRS]) rather than mortality is likely more meaningful for SAO patients.…”