Association between fasting blood glucose and outcomes and mortality in acute ischaemic stroke patients with diabetes mellitus: a retrospective observational study in Wuhan, China

Yao, Tao; Zhan, Yanqiang; Shen, Jing; Li, Xu; Peng, Bo; Cui, Qin; Liu, Zhichao

doi:10.1136/bmjopen-2020-037291

Cited by 10 publications

(7 citation statements)

References 46 publications

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“…However, it should be noted that the clinical factors included were not comprehensive, with the focus mainly being on the analysis of the DMV imaging index, and further grading of fasting glucose or qualification of the glycemic control and medication for patients was not applied. Nonetheless, previous studies ( 40 , 41 ) have confirmed that fasting glucose is one of the factors of AIS prognosis and that hyperglycemia is associated with poor prognosis, which is consistent with the results of this study.…”

Section: Discussionsupporting

confidence: 93%

Deep medullary veins as an important imaging indicator of poor prognosis in acute ischemic stroke: a retrospective cohort survey

Li¹,

Liu²,

Ju³

et al. 2023

Quant Imaging Med Surg

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Background The deep medullary veins (DMVs), which constitute a component of the intracerebral venous circulation system and are part of intracerebral reperfusion mechanisms, have been suggested as a novel imaging marker for cerebral white matter hypersignal and cerebral small vessel disease based on their discontinuous and reduced visual representation. However, the correlation between the number and continuity of visible DMVs and the poor prognosis of acute ischemic stroke (AIS) remains undefined. Magnetic susceptibility-weighted imaging was applied in this study to assess the distribution and structural characteristics of DMVs in patients with AIS and to investigate its relationship with the poor prognosis of those with AIS. Methods This retrospective study included 90 patients diagnosed with AIS in the middle cerebral artery region by the Neurology Department of Liaoning Provincial People’s Hospital. Clinical, laboratory, and cranial magnetic resonance imaging data were collected. After the 3-month follow-up visit, patients were dichotomized into good (0–2 points) and poor (≥3 points) prognosis groups based on the modified Rankin Scale score, and the DMV imaging characteristics were evaluated using a 3-level visual rating scale. The association between DMV and AIS prognosis was determined through Mann-Whitney test and multivariate logistic regression analysis. Results In univariate analysis, factors that were statistically significant between the different prognostic groups were DMV score (P=0.007), DMV symmetry (P=0.016), infarct size (P=0.029), and admission National Institutes of Health Stroke Scale (NIHSS) score (P<0.001). DMV score had a positive correlation with NIHSS score, (rs=0.209; P=0.048). Logistic regression analysis showed that the DMV score [odds ratio (OR), 1.356; 95% confidence interval (CI): 1.114–1.650; P=0.002], NIHSS score (OR, 1.280; 95% CI: 1.117–1.466; P<0.001), and fasting glucose (OR, 1.220; 95% CI: 1.023–1.456; P=0.027) were risk factors for poor prognosis in those with AIS. Conclusions Discontinuity in DMV visualization was found to be associated with an unfavorable prognosis for patients AIS. The visual assessment of DMV through susceptibility-weighted imaging has the potential to predict AIS prognosis and furnish valuable insights for clinical treatment.

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Section: Discussionsupporting

confidence: 93%

Deep medullary veins as an important imaging indicator of poor prognosis in acute ischemic stroke: a retrospective cohort survey

Li¹,

Liu²,

Ju³

et al. 2023

Quant Imaging Med Surg

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“…Previous studies reported that high FPG level was correlated with poor outcomes of ischemic stroke (23)(24)(25). A study reported that acute ischemic stroke patients with a favorable neurologic outcome (90-day mRS scores ≤ 2) had a significantly lower baseline FPG level than those with an unfavorable neurologic outcome (6.6 ± 1.96 vs. 8.12 ± 4.02; P = 0.002) (24).…”

Section: Discussionmentioning

confidence: 96%

Outcomes of Ischemic Stroke and Associated Factors Among Elderly Patients With Large-Artery Atherosclerosis: A Hospital-Based Follow-Up Study in China

Cui

Xie

et al. 2021

Front. Neurol.

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Large-artery atherosclerotic (LAA) stroke is the most common subtype of ischemic stroke. However, risk factors for long-term outcomes of LAA stroke in the elderly Chinese population have not been well-described. Therefore, we aimed to assess outcomes and risk factors at 3, 12, and 36 months after LAA stroke onset among stroke patients aged 60 years and older. All consecutive LAA patients aged ≥ 60 years were prospectively recruited from Dongying People's Hospital between January 2016 and December 2018. The clinical features and outcome data at 3, 12, and 36 months after stroke were collected. Differences in outcomes and relationship between outcomes and risk factors were assessed. A total of 1,772 patients were included in our study (61.7% male, 38.3% female). The rates of mortality, recurrence, and dependency were 6.6, 12.6, and 12.6%, respectively, at 3 months after stroke onset. The corresponding rate rose rapidly at 36 months (23.2, 78.7, and 79.7%, respectively). We found the positive predictors associated outcomes at 3, 12, and 36 months after stroke onset. The relative risk (RR) with 95% confidential interval (CI) is 1.06 (1.02–1.10, P = 0.006) at 3 months, 1.06 (1.02–1.10, P = 0.003) at12 months, and 1.10 (1.05–1.15, P < 0.001) at 36 months after stroke onset for age; 1.09 (1.01–1.19, P = 0.029) at 12 months for fasting plasma glucose (FPG) level; 4.25 (2.14–8.43, P < 0.001) at 3 months, 4.95 (2.70–9.10, P < 0.001) at 12 months, and 4.82 (2.25–10.32, P < 0.001) at 36 months for moderate stroke; 7.56 (3.42–16.72, P < 0.001) at 3 months, 11.08 (5.26–23.34, P < 0.001) at 12 months, and 14.30 (4.85–42.11, P < 0.001) at 36 months for severe stroke, compared to mild stroke. Hypersensitive C-reactive protein (hs-CRP) level was an independent risk factor for mortality at different follow-up times, with the RR (95%) of 1.02 (1.01–1.02, P < 0.001) at 3 months, 1.01 (1.00–1.02, P = 0.002) at 12 months. White blood cell count (WBC) level was associated with both stroke recurrence (RR = 1.09, 95%CI: 1.01–1.18, P = 0.023) and dependency (RR = 1.10, 95%CI: 1.02–1.19, P = 0.018) at 3 months. In contrast, a higher level of low-density lipoprotein cholesterol (LDL-C) within the normal range was a protective factor for recurrence and dependency at shorter follow-up times, with the RR (95%) of 0.67 (0.51–0.89, P = 0.005) and 0.67 (0.50–0.88, P = 0.005), respectively. These findings suggest that it is necessary to control the risk factors of LAA to reduce the burden of LAA stroke. Especially, this study provides a new challenge to explore the possibility of lowering LDL-C level for improved stroke prognosis.

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“…We calculated the P for the trend to verify the results of the TG/HDL-c ratio as the continuous variable and examine the possibility of the nonlinear relationship between the TG/HDL-c ratio and 3-month unfavorable outcomes (The method used was linear-by-linear association). Since unfavorable outcomes in patients with AIS were significantly associated with DM, abnormal FBG, hypercholesterolemia, and BMI [ 24 – 26 ], we excluded patients with DM, FBG ≥ 6.1 mmol/L, TC ≥ 200 mg/dL, and BMI ≥ 25 kg/m 2 for sensitivity analysis [ 27 – 29 ]. Additionally, we explored the potential for unmeasured confounding between the TG/HDL-c ratio and unfavorable outcomes by calculating E-values [ 30 ].…”

Section: Methodsmentioning

confidence: 99%

Association between triglyceride-to-high density lipoprotein cholesterol ratio and three-month outcome in patients with acute ischemic stroke: a second analysis based on a prospective cohort study

et al. 2022

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Objective Evidence regarding the relationship between serum triglyceride-to-high density lipoprotein cholesterol (TG/HDL-c) ratio and outcomes in acute ischemic stroke (AIS) patients is still mixed. Therefore, the present study was undertaken to explore the link between the TG/HDL-c ratio and unfavorable outcomes in patients with AIS. Methods This was a second analysis based on a cohort study. The study population was 1764 patients with AIS collected from January 2010 to December 2016 at a hospital in South Korea. We used a binary logistic regression model to assess the linear association between the TG/HDL-c ratio and unfavorable outcomes for AIS patients. A generalized additive model (GAM) and smooth curve fitting (penalized spline method) was conducted to explore the nonlinear relationship between TG/HDL-c ratio and unfavorable outcomes for AIS patients. Additionally, we compute the inflection point using a recursive algorithm and then build a two-piece binary logistic regression model on both sides of the inflection point. A log-likelihood ratio test was used to determine the most appropriate model describing the association of TG/HDL-c ratio and unfavorable outcomes in patients with AIS. Results The incidence rate of unfavorable outcomes was 28.2%, and the median TG/HDL-c ratio was 2.130. After adjusting covariates, the results of the binary logistic regression model suggested that the relationship between the TG/HDL-c ratio and the risk of unfavorable outcomes for AIS patients was not statistically significant. However, there was a nonlinear relationship between them, and the inflection point of the TG/HDL-c ratio was 3.515. On the left side of the inflection point, each 1-unit increase in the TG/HDL-c ratio was associated with a 22.6% lower risk of unfavorable outcomes (OR = 0.774, 95%CI:0.656 to 0.914, p = 0.002). On the right side of the inflection point, the effect size (OR) was 1.195 (95%CI:1.004 to1.423, p = 0.003). Conclusion There is a nonlinear relationship and threshold effect between the TG/HDL-c ratio and 3-month unfavorable outcomes in AIS patients. When the TG/HDL-c ratio is lower than 3.515, the TG/HDL-c ratio is significantly negatively related to the risk of unfavorable outcomes. When the TG/HDL-c ratio is greater than 3.515, the TG/HDL-c ratio was positively associated with the risk of unfavorable outcomes in AIS patients. This provides a reference for optimizing lipidemia intervention and promoting clinical communication in patients with AIS.

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Association between fasting blood glucose and outcomes and mortality in acute ischaemic stroke patients with diabetes mellitus: a retrospective observational study in Wuhan, China

Cited by 10 publications

References 46 publications

Deep medullary veins as an important imaging indicator of poor prognosis in acute ischemic stroke: a retrospective cohort survey

Deep medullary veins as an important imaging indicator of poor prognosis in acute ischemic stroke: a retrospective cohort survey

Outcomes of Ischemic Stroke and Associated Factors Among Elderly Patients With Large-Artery Atherosclerosis: A Hospital-Based Follow-Up Study in China

Association between triglyceride-to-high density lipoprotein cholesterol ratio and three-month outcome in patients with acute ischemic stroke: a second analysis based on a prospective cohort study

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