Effects of perioperative glycemic indicators on outcomes of endovascular treatment for vertebrobasilar artery occlusion

Gu, Mengmeng; Jin, Fan; Xu, Pengfei; Xiao, Lulu; Wang, Jinjing; Li, Min; Liu, Chaolai; Luo, Genpei; Cai, Qiankun; Liu, Dezhi; Ye, Lichao; Zhou, Junshan; Sun, Wen

doi:10.3389/fendo.2022.1000030

Cited by 4 publications

(4 citation statements)

References 33 publications

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Section: Discussionmentioning

confidence: 99%

“…Our prior research has demonstrated that elevated admission FBG levels are significantly associated with an increased risk of poor outcomes and sICH. 28 Hyperglycemia may exacerbate oxidative stress, compromise blood-brain barrier integrity post-cerebral ischemia/reperfusion injury, and heighten the risk of brain edema and hemorrhagic transformation, leading to expanded infarct volume and greater neurological deficits. 28 Circulation insufficiency emerged as the strongest predictor for PMV in the PAIRS score.…”

Section: Mechanism Of Associationsmentioning

confidence: 99%

“…28 Hyperglycemia may exacerbate oxidative stress, compromise blood-brain barrier integrity post-cerebral ischemia/reperfusion injury, and heighten the risk of brain edema and hemorrhagic transformation, leading to expanded infarct volume and greater neurological deficits. 28 Circulation insufficiency emerged as the strongest predictor for PMV in the PAIRS score. Patients with circulation insufficiency often struggle to meet the weaning criteria due to unstable cardiovascular status.…”

Section: Mechanism Of Associationsmentioning

confidence: 99%

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Predicting prolonged mechanical ventilation after endovascular treatment for acute vertebrobasilar artery occlusion

Cai,

Hong,

et al. 2023

Preprint

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BackgroundPatients with acute vertebrobasilar artery occlusion (VBAO) after endovascular treatment (EVT) frequently require mechanical ventilation (MV). This study aims to develop and validate a predictive score for prolonged mechanical ventilation (PMV) in patients with VBAO after EVT.MethodsThe derivation cohort prospectively recruited acute VBAO patients undergoing EVT from four comprehensive stroke centers (CSCs) in China. PMV was defined as continuous MV for ≥96 hours. Two multivariable logistic regressions were performed to predict predictive models based on whether adding radiographic results at follow-up. The performance of two models was evaluated for discrimination, calibration, and clinical utility. A validation cohort of 444 patients from acute Posterior circulation ischemic Stroke registry was enrolled to validate two models.ResultsThe derivation cohort consisted of 498 patients from four CSCs, among whom 204 (41.0%) required PMV. Reperfusion status, National Institutes of Health Stroke Scale scores, collateral circulation status, history of atrial fibrillation, fasting blood glucose, circulation insufficiency, the presence of malignant cerebellar edema, and symptomatic intracranial hemorrhage at follow-up imaging were found to be independent predictors of PMV in multivariable logistic regression. These variables were combined to create the basic and radiographic PAIRS scores. The basic PAIRS and radiographic PAIRS scores demonstrated adequate discrimination in derivation cohort (C-index, 0.77 [95%CI 0.73 to 0.81] and 0.80 [95%CI 0.77 to 0.84]), as well as the validation cohort (C-index, 0.70 [95%CI 0.65 to 0.75] and 0.75 [95%CI 0.70 to 0.80]), and had well-fitted calibration plot for both cohorts. Decision curve analysis showed that both PAIRS scores had satisfied net benefit in predicting PMV across various thresholds.ConclusionsThe PAIRS scores provide adequate accurate predictions of PMV in VBAO patients after EVT. These findings can assist patient families and caregivers in better understanding the treatment trajectory.

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Section: Discussionmentioning

confidence: 99%

Section: Mechanism Of Associationsmentioning

confidence: 99%

Section: Mechanism Of Associationsmentioning

confidence: 99%

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Predicting prolonged mechanical ventilation after endovascular treatment for acute vertebrobasilar artery occlusion

Cai,

Hong,

et al. 2023

Preprint

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“…A number of studies used the stress hyperglycemia ratio (SHR) as a tool to evaluate stress hyperglycemia (15,16). Moreover, many studies have been found that SHR is associated with poor prognosis in AIS patients (17)(18)(19). Recent evidence revealed that elevated SHR was a clinical predictor of stroke-associated pneumonia (9).…”

Section: Introductionmentioning

confidence: 99%

The association between neutrophil counts and neutrophil-to-lymphocyte ratio and stress hyperglycemia in patients with acute ischemic stroke according to stroke etiology

et al. 2023

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Background and purposeStress hyperglycemia ratio (SHR), which is used to assess stress hyperglycemia, is associated with the functional outcome of ischemic stroke (IS). IS can induce the inflammatory response. Neutrophil counts and neutrophil-to-lymphocyte ratio (NLR) as good and easily available inflammatory biomarkers, the relationship between neutrophil counts and NLR and SHR were poorly explored in IS. We aimed to systemically and comprehensively explore the correlation between various blood inflammation markers (mainly neutrophil counts and NLR) and SHR.MethodsData from 487 patients with acute IS(AIS) in Xiangya Hospital were retrospectively reviewed. High/low SHR groups according to the median of SHR (≤1.02 versus >1.02). Binary logistic regression analysis was used to evaluate the correlation between neutrophil counts and NLR and high SHR group. Subgroup analyses were performed in the TOAST classification and functional prognosis.ResultsThe neutrophil counts and NLR were all clearly associated with SHR levels in different logistic analysis models. In the subgroup analysis of TOAST classification, the higher neutrophil counts and NLR were the independent risk factors for high SHR patients with large-artery atherosclerosis (LAA) (neutrophil: adjusted OR:2.047, 95% CI: 1.355-3.093, P=0.001; NLR: adjusted OR:1.315, 95% CI: 1.129-1.530, P<0.001). The higher neutrophil counts were the independent risk factor for high SHR patients with cardioembolism (CE) (adjusted OR:2.413, 95% CI: 1.081-5.383, P=0.031). ROC analysis showed that neutrophil counts was helpful for differentiating high SHR group with CE and low SHR group with CE (neutrophil: AUC =0.776, P=0.002). However, there were no difference in levels of neutrophil counts and NLR between patients with SVO and without SVO. The higher neutrophil counts and NLR independently associated with high SHR patients with mRS ≤2 at 90 days from symptom onset, (neutrophil: adjusted OR:2.284, 95% CI: 1.525-3.420, P<0.001; NLR: adjusted OR:1.377, 95% CI: 1.164-1.629, P<0.001), but not in patients with mRS >2.ConclusionsThis study found that the neutrophil counts and NLR are positively associated with SHR levels in AIS patients. In addition, the correlation between neutrophil counts and NLR and different SHR levels are diverse according to TOAST classification and functional prognosis.

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Treatments, medical expenses and complications of hospital outpatient healthcare associated with stroke in patients with diabetes in China: a retrospective analysis of the Beijing Municipal Medical Insurance Database

Zeng,

Liang,

Wang

et al. 2024

BMJ Open

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ObjectivesDiabetes is closely associated with risk of stroke and its adverse sequelae. Approximately 20%–33% of patients with stroke have diabetes. In China, however, it is unclear how stroke affects healthcare utilisation, medications and complications among people with diabetes. This study aimed to analyse the clinical characteristics, treatment options, medical expenses and complications of hospital outpatient healthcare associated with stroke in patients with diabetes in China.DesignA retrospective, multicentre, observational study.SettingBeijing Municipal Medical Insurance Database, with data from 2016 to 2018.ParticipantsThe study included patients with diabetes whose data included 2016–2018 outpatient medication records and who had Beijing medical insurance. Patients who did not have continuous prescription records for more than 2 months were excluded from the analysis. In total, 2 853 036 people with diabetes were included, and patients who had and did not have a stroke were compared.ResultsIn our study, 19.75%–22.30% of patients with diabetes suffered from stroke between 2016 and 2018. The average annual medical cost for a patient diagnosed with diabetes is ¥9606.65, and the cost increases to ¥13 428.39 when diabetes was combined with stroke; thus, stroke increases the medical cost for patients with diabetes by 39.78% (p<0.0001). Among patients with diabetes who had a stroke, 4.76 medications were used (1.8 hypoglycaemic drugs and 2.97 non-hypoglycaemic drugs); these numbers were significantly greater than for patients with diabetes who did not have a stroke receiving both hypoglycaemic drugs and non-hypoglycaemic drugs (p<0.0001). Among patients with diabetes who did not have a stroke, 3.58 medications were used (1.66 hypoglycaemic drugs and 1.92 non-hypoglycaemic drugs). Patients with diabetes who had a stroke also had significantly greater incidences of diabetic peripheral neuropathy, diabetic kidney disease, diabetic retinopathy and diabetic angiopathy than those who did not have a stroke (p<0.0001). These drugs and costs increased with the number of complications (p<0.0001). The increased medical costs for each specific complication are also listed. We also analysed the medical costs and medication regimens stratified by sex, age group and complications.ConclusionsStroke is associated with a significant increase in complications and medications for patients with diabetes and greatly adds to the economic burden of these patients. Early identification of stroke risk factors in patients with diabetes, as well as targeted poststroke diabetes management, is crucial from a socioeconomic perspective for a comprehensive management and treatment of stroke in patients with diabetes.

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Effects of perioperative glycemic indicators on outcomes of endovascular treatment for vertebrobasilar artery occlusion

Cited by 4 publications

References 33 publications

Predicting prolonged mechanical ventilation after endovascular treatment for acute vertebrobasilar artery occlusion

Predicting prolonged mechanical ventilation after endovascular treatment for acute vertebrobasilar artery occlusion

The association between neutrophil counts and neutrophil-to-lymphocyte ratio and stress hyperglycemia in patients with acute ischemic stroke according to stroke etiology

Treatments, medical expenses and complications of hospital outpatient healthcare associated with stroke in patients with diabetes in China: a retrospective analysis of the Beijing Municipal Medical Insurance Database

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