Elevated Glycated Hemoglobin Levels Are Associated With Poor Outcome in Acute Ischemic Stroke

Abstract

ObjectiveAdmission hyperglycemia is an established risk factor for functional outcome in patients with acute ischemic stroke. However, the association between glycated hemoglobin (HbA1c) and prognosis in patients with acute anterior circulation ischemic stroke (AACIS) remains controversial. This study aimed to explore whether elevated HbA1c levels are associated with functional outcome in AACIS patients.Participants and MethodsWe enrolled patients with AACIS hospitalized in the First Hospital Affiliated to Soochow University from March 2018 to January 2021. Patients were categorized into three groups based on baseline HbA1c: HbA1c ≤ 6.5%, 6.5% < HbA1c ≤ 8.0%, and HbA1c > 8.0%. Ninety-day modified Rankin Scale scores of 0–1 and 0–2 were defined as excellent and favorable functional outcome, respectively. Early neurological improvement was regarded as a reduction in the National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 points compared with that on admission, or an NIHSS score of 0–1 at discharge. The association between HbA1c and clinical outcome in acute ischemic patients was assessed by logistic regression and adjusted for confounding factors. Subgroup analyses by TOAST classification were also conducted.ResultsThe study included 326 patients. The proportion with favorable outcome was significantly lower in the HbA1c > 8.0% group than the HbA1c ≤ 6.5% group (30.4 vs. 55.2%; p < 0.01). Binary logistic regression analysis demonstrated that increasing HbA1c levels (as a continuous variable) were associated with reduced functional independence (adjusted OR = 0.739; 95% CI: 0.605–0.904; p = 0.003). In subgroup analyses, higher HbA1c was also associated with favorable outcome in large-artery atherosclerosis (LAA)-type patients (adjusted OR = 0.776; 95% CI: 0.614–0.981; p = 0.034), but not in LAA group.ConclusionsHbA1c level was an independent predictor of worse functional outcome in patients with AACIS, particularly in those with LAA. For patients with anterior circulation atherosclerosis, strict adherence to a target HbA1c < 6.5% may be required.

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“…Additionally, with rising HbA1c levels (HbA1c >8%), patients experience reduced functional independence. [18] The subgroup analysis based on baseline HbA1c levels between RE+TE10 and TE20 demonstrated a significant difference between two groups in HbA1c 9-9.9% subgroup (p=0.003), achieving HbA1c <7.5% with RE+TE10 at Week 16 from baseline, suggesting better outcomes for patients in this subgroup while for the other two subgroups (HbA1c 8-8.9% and 10-11%) difference was not statistically significant (Table 2). The reason of this findings could be the small no of patients in these subgroups.…”

Association between glycated hemoglobin and functional outcomes in patients with intracranial large artery atherosclerotic disease-related acute ischemic stroke: identifying the magic number

“…However, none of these studies have separately described the effects of HbA1c on ICLAD-related stroke. Nevertheless, the association between poor FOC and HbA1c >8% as compared to HbA1c ≤6.5% and 6.5 to ≤8% in patients with the LAA stroke subtype compared to those with the non-LAA type has been recently established by Dong et al ( 9 ). Similarly, Diprose et al reported that HbA1c is an independent predictor of poor outcomes following EVT.…”

“…Researchers from China have investigated the effect of admission HbA1c on functional outcomes (FOC) in AIS ( 7 – 9 ). Gao et al found HbA1c ≥6.7% to be associated with an unfavorable outcome in 793 patients with AIS due to small vessel occlusion ( 7 ), whereas Wang et al identified HbA1c ≥6.5% as an independent risk factor for adverse outcomes among 408 patients with AIS ( 8 ).…”

“…Gao et al found HbA1c ≥6.7% to be associated with an unfavorable outcome in 793 patients with AIS due to small vessel occlusion ( 7 ), whereas Wang et al identified HbA1c ≥6.5% as an independent risk factor for adverse outcomes among 408 patients with AIS ( 8 ). Moreover, Dong et al analyzed 326 patients with acute anterior ischemic circulation stroke and reported that HbA1c >8% was significantly correlated with a poor FOC, which persisted after adjustment for confounding factors in patients with LAA stroke subtypes ( n = 182) but not in those with non-LAA subtypes ( 9 ). Apart from these studies, some studies have reported HbA1c ≥7% to be significantly associated with poor FOC in AIS ( 10 ).…”

Effect of sacubitril/valsartan on brain natriuretic peptide level and prognosis of acute cerebral infarction

“…In addition, brain tissue damage in ACI patients can cause dysregulation of the hindbrain-cardiac axis, stimulating increased production of cardiacderived BNP, which can further cause cardiac damage [18]. The following are possible explanations for the underlying mechanisms of the hindbrain-cardiac axis: HPA axis activation, sympathetic and parasympathetic regulation, catecholamine surge, dysregulation of the gut microbiota, immune response, and release of inflammatory particles and microRNAs [19,20]. BNP, Corin, and NEP are all important components of natriuretic peptides (NPs) [21,22].…”