Elevated glucose level adversely affects infarct volume growth and neurological deterioration in non‐diabetic stroke patients, but not diabetic stroke patients

Shimoyama, Takashi; Kimura, Kazumi; Uemura, Junichi; Saji, Naoki; Shibazaki, Kensaku

doi:10.1111/ene.12280

Cited by 53 publications

(65 citation statements)

References 23 publications

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“…13 But in the recent studies, it has been seen that increased mortality is seen in patients with stroke and stress hyperglycemia. [14][15][16] In our study, there was as slight preponderance of males over females, though this was not found to be significant. Among the stroke patients the age group where diabetes was more common was 51-60 years in our study.…”

Section: Discussioncontrasting

confidence: 81%

Prevalence of diabetes among stroke patients: a study in a tertiary care centre

Rao¹,

Reddy

2016

Int J Adv Med

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Section: Discussioncontrasting

confidence: 81%

Prevalence of diabetes among stroke patients: a study in a tertiary care centre

Rao¹,

Reddy

2016

Int J Adv Med

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“…Glucose was significantly higher with IS-END [2, and ICH-END [37], which may have numerous explanations including poorer collateral flow, endothelial damage, increased oxidative stress and lactate, haemorrhagic transformation and dysregulation of glucose energy metabolism [38]. This was mirrored in glycosylated haemoglobin A1c, a marker of chronic raised glucose, also predicting END [9,23,25,26,29,30,35,39] [5K].…”

Section: Metabolic Biomarkersmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of Molecular Biomarkers Associated with Early Neurological Deterioration Following Acute Stroke

Martin

Price

2018

Cerebrovasc Dis

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Background: Early neurological deterioration (END) following acute stroke is associated with poorer long-term outcomes. Identification of patients at risk could assist early monitoring and treatment decisions. This review summarised the evidence describing non-radiological biomarkers for END. Summary: Electronic searches from January 1990 to March 2017 identified studies reporting a blood/cerebrospinal fluid (CSF)/urine biomarker measurement within 24 h of acute stroke and at least 2 serial assessments of clinical neurological status (< 24 h and < 7 days). Out of 12,895 citations, 82 studies were included, mostly focusing on ischaemic stroke. Using higher neurological thresholds, the n-weighted END incidence for ischaemic stroke was 11.9% (95% CI 11.4–12.4%) and 18.6% (17.9–19.2%) for lower thresholds. Incidence decreased with advancing study publication year (Pearson r-squared 0.23 and 0.15 for higher and lower threshold studies). After classification into 3 broad categories, meta-analysis showed that biomarkers associated with increased END risk (n; fixed-effects mean difference; 95% CI) were “metabolic” (glucose [n = 9,481; 0.90 mmol/L; 0.74–1.06], glycosylated haemoglobin [n = 3,146; 0.33%; 0.19–0.46], low-density lipoprotein [n = 4,839; 0.13 mmol/L; 0.06–0.21], total cholesterol [n = 4,762; 0.21 mmol/L; 0.11–0.31], triglycerides [n = 4,820; 0.11 mmol/L; 0.06–0.17], urea [n = 1,351; 0.55 mmol/L; 0.14–0.96], decreasing albumin [n = 513; 0.33 g/dL; 0.05–0.61]); “inflammatory and excitotoxic” (plasma glutamate [n = 688; 60.13 µmol/L; 50.04–70.22], CSF glutamate [n = 369; 7.50 µmol/L; 6.76–8.23], homocysteine [n = 824; 2.15 µmol/L; 0.68–3.61], leucocytes [n = 3,766; 0.54 × 10⁹/L; 0.34–0.74], high-sensitivity C-reactive protein [n = 1,707; 3.79 mg/L; 1.23–6.35]); and “coagulation/haematological” (fibrinogen [n = 3,132; 0.32 g/L; 0.25–0.40]; decreasing haemoglobin [n = 3,586; 2.38 g/L; 0.15–4.60]). Key Messages: Declining incidence of END may represent improving care standards; however, it remains a frequent occurrence. Although statistical associations exist between biomarkers and an increased risk of END, the most promising still need prospective evaluation to determine their additional value relative to baseline radiological and clinical characteristics.

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“…3 Furthermore, an elevated glucose level is associated with increased infarct volume and neurological deterioration in patients without diabetes mellitus, but not in patients with diabetes mellitus. 4 These findings indicate that acute hyperglycemia may be more harmful in nondiabetic cases. In animal models of ischemic stroke, induction of hyperglycemia before stroke was significantly associated with increased infarct volume 5,6 and blood-brain barrier (BBB) permeability and hemorrhagic transformation with or without thrombolysis.…”

mentioning

confidence: 96%

Exendin-4 Inhibits Matrix Metalloproteinase-9 Activation and Reduces Infarct Growth After Focal Cerebral Ischemia in Hyperglycemic Mice

Kuroki

Tanaka

Shimada

et al. 2016

Stroke

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Background and Purpose-Admission hyperglycemia is an independent risk factor for poor outcome of ischemic stroke. Amelioration of hyperglycemia by insulin has not been shown to improve the poststroke outcome. Glucagonlike peptide 1 receptor agonists, which modulate glucose levels by stimulating insulin secretion, have been shown to exert cytoprotective effects by inhibiting inflammation and oxidative stress. This study aimed to evaluate whether the glucagon-like peptide 1 receptor agonist exendin-4 could reduce glucose levels and exert protective effects after acute focal ischemia in hyperglycemic mice. Methods-Hyperglycemia was induced by intraperitoneal injection of dextrose 15 minutes before transient middle cerebral artery occlusion was performed for 60 minutes using an intraluminal thread. We assessed 4 groups: (1) normal glucose (vehicle control), (2) Key Words: brain ischemia ◼ glucagon-like peptide 1 ◼ hyperglycemia ◼ insulin ◼ matrix metalloproteinase 9 ◼ tumor necrosis factor-alpha

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Elevated glucose level adversely affects infarct volume growth and neurological deterioration in non‐diabetic stroke patients, but not diabetic stroke patients

Abstract: Glucose level appears to influence infarct volume growth and neurological deterioration, particularly in non-diabetic patients with ischaemic stroke.

Cited by 53 publications

References 23 publications

Prevalence of diabetes among stroke patients: a study in a tertiary care centre

Prevalence of diabetes among stroke patients: a study in a tertiary care centre

A Systematic Review and Meta-Analysis of Molecular Biomarkers Associated with Early Neurological Deterioration Following Acute Stroke

Exendin-4 Inhibits Matrix Metalloproteinase-9 Activation and Reduces Infarct Growth After Focal Cerebral Ischemia in Hyperglycemic Mice

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