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

Zhang, G.; He, Ming; Xu, Yaping; Li, X.; Cai, Zhenzhen; Guo, Zhigang; Meng, Pin; Ji, Ningfei; He, Xianghuo; Pang, Lizhi

doi:10.1111/ene.13747

Cited by 20 publications

(12 citation statements)

References 45 publications

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“…There are a limited number of South Asian studies exploring causes and mechanism of hemorrhagic transformation. In contrast to our study, some studies done in China suggested an association between raised HbA1c and hemorrhagic transformation [ 13 , 14 ]. In a prospective cohort study conducted in Lianyungang Hospital in China, 426 patients with anterior ischemic stroke were included and HbA1c was found to be a predictor of hemorrhagic transformation [ 13 ].…”

Section: Discussioncontrasting

confidence: 99%

Association Between Raised HbA1c Levels and Hemorrhagic Transformation in Patients With Ischemic Stroke

Afzal¹,

Jamil²

2021

Cureus

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BackgroundGlycated hemoglobin (HbA1c) is a commonly used indicator of glycemic control in diabetes mellitus. Uncontrolled diabetes can lead to cardiovascular complications. Ischemic strokes are often complicated by hemorrhagic transformation, which is the conversion of an infarcted area into an area of hemorrhage. The purpose of this study is to determine the association of raised HbA1c levels with the occurrence of hemorrhagic transformation in ischemic stroke. MethodsThis is a prospective, single-center cohort study of patients admitted to the Neurology and Medicine wards between June 1 and November 30, 2019. Inclusion criteria included adult patients who were admitted with acute ischemic stroke and had been tested for HbA1c on presentation. There were 110 ischemic stroke patients enrolled in our database. An HbA1c level >53 mmol/mol was considered raised. A comparison was done between the group with raised HbA1c levels and the group with target levels of HbA1c for the occurrence of hemorrhagic transformation. Brain imaging was used to diagnose hemorrhagic transformation. ResultsOut of 110 study participants with ischemic stroke, 70 (63.6%) patients had a history of prior known diabetes. The mean HbA1c levels were 7.44 ± 1.79%. A total of 77% of diabetic patients had raised HbA1c levels (>7%). Hemorrhagic transformation was seen in 21 (19.1%) patients, of whom only 38% (n=8) had raised HbA1c levels. The association between raised HbA1c and hemorrhagic transformation was not found to be statistically significant (p = 0.225). ConclusionIn this study of patients with ischemic stroke, raised HbA1c levels were not found to be associated with hemorrhagic transformation. There is a need for larger scale studies to find out the cause and mechanism of hemorrhagic transformation in ischemic stroke.

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Section: Discussioncontrasting

confidence: 99%

Association Between Raised HbA1c Levels and Hemorrhagic Transformation in Patients With Ischemic Stroke

Afzal¹,

Jamil²

2021

Cureus

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“…We found an association between higher levels of HbA1c, ceramide score and specific ceramide levels and ratios with worse neurological outcomes. Our findings are consistent with previous reports on hemoglobin A1c levels [38][39][40] as well as association of elevated C18:0-ceramide levels with poor outcomes for stroke patients [41]. Rather than individual ceramide level dynamics we found the C18:0/C24:0 ratio to be the stronger prognostic factor as it reflects the dynamics of both classes of ceramides that have undergone temporal change, long-chain and very-long chain.…”

Section: Discussionsupporting

confidence: 92%

Ceramide Dynamics and Prognostic Value in Acute and Subacute Ischemic Stroke: Preliminary Findings in a Clinical Cohort

et al. 2020

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“…In addition, we found that high fasting blood glucose was associated with HT in AIS patients. Similarly, a prospective study of 426 patients with acute anterior stroke reported that high blood glucose and HbA1c levels were strong independent predictors of HT, and that hyperglycemia may function in the pathology of HT [27]. These results suggest those patients with low T3 syndrome who did not develop HT may have been protected by factors such as less severe stroke (lower NIHSS score), the absence of atrial fibrillation, and lower glucose levels.…”

Section: Discussionmentioning

confidence: 95%

Low triiodothyronine syndrome is associated with hemorrhagic transformation in patients with acute ischaemic stroke

Huang

Zeng

Cheng

et al. 2019

Aging

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Hemorrhagic transformation (HT) is a severe complication occurring in acute ischemic stroke (AIS) patients. We explored the association between low triiodothyronine (T3) syndrome and HT in AIS patients. A total of 208 consecutive participants with HT and 208 age- and sex-matched stroke patients without HT were enrolled in this study. HT was diagnosed by follow-up imaging assessment, and was radiologically classified as hemorrhagic infarction (HI) type 1 or 2 or parenchymal hematoma (PH) type 1 or 2. HT was also classified into asymptomatic or symptomatic. The incidence of low T3 syndrome was significantly higher among patients who developed HT than among those without HT. Moreover, the more severe the HT, the lower the detected T3 levels. Multivariate-adjusted binary logistic regression showed that low T3 syndrome was an independent risk factor for HT and symptomatic HT in AIS patients. Low T3 syndrome was also significantly associated with a higher risk of PH, but not with the risk of HI. Thus, low T3 syndrome was independently associated with the risk of HT, symptomatic HT, and severe HT (PH) in AIS patients, which suggests monitoring T3 could be a useful means of preventing HT in patients with ischemic stroke.

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

Abstract: Higher HbA1c was independently related to HT and poor neurological outcomes in patients with ischaemic stroke. These findings have significant implications for the treatment of diabetes and glucose management in patients with diabetes mellitus and/or acute ischaemic stroke.

Cited by 20 publications

References 45 publications

Association Between Raised HbA1c Levels and Hemorrhagic Transformation in Patients With Ischemic Stroke

Association Between Raised HbA1c Levels and Hemorrhagic Transformation in Patients With Ischemic Stroke

Ceramide Dynamics and Prognostic Value in Acute and Subacute Ischemic Stroke: Preliminary Findings in a Clinical Cohort

Low triiodothyronine syndrome is associated with hemorrhagic transformation in patients with acute ischaemic stroke

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