Impact of Stress Hyperglycemia on Early Neurological Deterioration in Acute Ischemic Stroke Patients Treated With Intravenous Thrombolysis

Cheng, Qingqing; Hu, Ting; Wang, Nuo; Wei, Xiue; Wu, Tao; Bi, Xiaoying

doi:10.3389/fneur.2022.870872

Cited by 24 publications

(28 citation statements)

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“…Excluding glycemic factors, no general statistics and stroke risk factors were found to influence post-rt-PA thrombolytic ENI in stroke patients. Our findings are consistent with previous findings that patients with severe stress hyperglycemia have a higher risk of developing END after IV-rt PA, confirming that blood glucose is a marker of poor prognosis in patients undergoing intravenous thrombolytic therapy for ischemic stroke ( 8 ). Ribo et al ( 12 ) studied that the acute increase in blood glucose after stroke would hinder the process of fibrinolysis and affect the blood reperfusion in the ischemic penumbra.…”

Section: Discussionsupporting

confidence: 93%

“…It is speculated that the reason may be the differences in the grouping criteria of this study and other studies and the different definitions of ENI (benefit or worsening) after rt-PA intravenous thrombolysis in acute stroke. For example, Wang Ling et al defined 24 h NIHSS score ≥4 as early neurological deterioration ( 8 ). Kim et al defined 24 h NIHSS score ≥2 as early neurological deterioration ( 9 ).…”

Section: Discussionmentioning

confidence: 99%

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Analysis of influencing factors of early neurological improvement after intravenous rt-PA thrombolysis in acute anterior circulation ischemic stroke

et al. 2022

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Background and objectiveIt has been widely reported that Early neurological improvement (ENI) after rt-PA intravenous thrombolysis contributes to a good long-term prognosis in patients experiencing acute ischemic stroke (AIS). However, which clinical factors influence after intravenous administration of recombinant tissue-type plasminogen activator (IV-rt PA) in AIS patients ENI is still unclear. This study aimed to evaluate the impact of influencing factors on the benefit of ENI after intravenous thrombolysis neurological improvement after IV-rt PA.MethodsThe data of 73 patients with acute anterior circulation ischemic stroke who received intravenous thrombolysis with rt-PA in Chongqing University Jiangjin Hospital from January 2021 to July 2022 were retrospectively studied. According to the change rate of 24 h NISHH score, the research subjects were divided into the recovery group, the significant curative effect group, the curative effect group and the no curative effect group, the ENI after intravenous thrombolysis with rt-PA was defined as the improvement rate of National Institutes of Health Stroke Scale (NIHSS)score >46% at 24 h after IV-rt PA, and univariate factor analysis was used Clinical factors associated with ENI after intravenous thrombolysis.ResultsAccording to the 24-h NIHSS improvement rate of rt-PA intravenous thrombolysis in patients with acute anterior circulation ischemic stroke, 35 cases (47.95%) of the study population had ENI. There was no statistical difference between the improvement and non-improvement group in general demographic data, stroke TOAST classification, stroke risk factors (history of stroke, heart disease, hyperlipidemia, hypertension), and laboratory test data. There was a statistically significant difference in the random blood glucose levels between the two groups (p < 0.001, t = 3.511).ConclusionThe effect of rt-PA intravenous thrombolysis within the time window of patients with acute anterior circulation ischemic stroke is significant, but the ENI after thrombolysis is easily affected by the level of blood glucose; diabetes is the most important factor affecting the acute anterior circulation ischemic stroke patients Clinical factors of ENI after intravenous thrombolysis with rt-PA.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Analysis of influencing factors of early neurological improvement after intravenous rt-PA thrombolysis in acute anterior circulation ischemic stroke

et al. 2022

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“…A total of 150 records were identified. Twenty-one articles underwent a full-text evaluation, five of which were excluded (one for inappropriate study design, three for inappropriate topic, and one for Chinese publication), leaving altogether sixteen studies in this systematic review and meta-analysis ( 18 – 33 ). The flowchart based on PRISMA is summarized in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Many studies evaluating the association between SHR and clinical outcomes in patients with stroke have been performed in recent years ( 18 – 33 ). But whether SHR is associated with clinical outcomes in stroke patients remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Association of the stress hyperglycemia ratio and clinical outcomes in patients with stroke: A systematic review and meta-analysis

Huang

2022

Front. Neurol.

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ObjectiveStress hyperglycemia (SH) is common in patients with acute diseases, such as stroke and myocardial infarction. Stress hyperglycemia ratio (SHR) is calculated by glucose/glycated hemoglobin and has been widely used for evaluating SH. But whether SHR is associated with clinical outcomes in stroke patients remains unclear so far. Although many studies have shown that higher SHR means poor outcomes, there is still no absolute evidence that SHR plays a critical role in stroke patients. Hence, we performed a systematic review and meta-analysis aiming to investigate the association between SHR and clinical outcomes in stroke patients.MethodsWe performed a comprehensive literature search of the PubMed, Embase, Cochrane Library databases, Clinicaltrials.gov, and WHO-ICTRP. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we performed our study. The Newcastle-Ottawa Scale (NOS) tool was used to examine the potential bias of included studies. The endpoints including poor outcome, mortality, neurological deficit, hemorrhagic transformation (HT), and infectious complications were statistically analyzed.ResultsSixteen retrospective studies met the eligibility criteria, and a number of 183,588 patients were included. Our meta-analysis demonstrated a significant increase in the incidence of poor outcome, according to assessment by the modified Rankin Scale (mRS) ≥ 3 points [odds ratio (OR) 2.53, 95% confidence interval (CI) 1.99–3.22, P < 0.00001, I2 = 68%], mortality (OR 1.96, 95% CI 1.58–2.44, P < 0.00001, I2 = 61%), neurological deficit (OR 1.99, 95% CI 1.47–2.70, P < 0.00001, I2 = 75%), hemorrhagic transformation (HT) (OR 3.70, 95% CI 2.69–5.08, P < 0.00001, I2 = 0%), and infectious complications [(Pneumonia) OR 2.06, 95% CI 1.57–2.72, P < 0.00001, I2 = 24%; (Urinary tract infection) OR 2.53, 95% CI 1.45–4.42, P = 0.001, I2 = 57%] in stroke patients with higher SHR. However, no significant influence was observed for recanalization rate (OR 0.86, 95% CI 0.54–1.38, P = 0.53, I2 = 0%).ConclusionWith or without diabetes, no matter whether undergoing intravenous thrombolysis or mechanical thrombectomy, higher SHR significantly increased the occurrence of poor outcomes, mortality, neurological deficit, HT, and infectious complications. The recanalization rate was not statistically significant between the two groups. More attention must be paid in clinical practice to SH. Future investigation should focus on the diagnostic value of SHR and the early control of hyperglycemia. Meanwhile, whether SHR could become a novel and promising target for early intervention is worthy of attention in further research. Besides, the influence of the dynamic change of glucose-to-HbA1c ratio, namely SHR, on intracerebral hemorrhage outcomes requires further investigation in future research. Although no randomized double-blind studies have been conducted, the available massive sample studies reflect the actual situation in the clinic and assist clinical decision makers.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42022345587.

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“…Early neurological deterioration (END) after AIS is a prominent clinical issue that is strongly correlated with poor functional outcome and mortality after AIS [9,10]. Metabolic factors such as hyperglycemia and DM have been identi ed as contributing factors for END [9,11]. Several studies have reported a signi cant correlation between disturbed glucose metabolism and early END [5,12], however, inconsistent conclusions exist regarding which AGM status increases the risk of END.…”

Section: Introductionmentioning

confidence: 99%

Impact of abnormal glucose metabolism on the early neurological outcome in acute ischemic stroke patients treated with intravenous thrombolysis

Hu¹,

Wang

Liu³

et al. 2022

Preprint

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Background and purpose: Abnormal glucose metabolism status (AGM), including prediabetes and diabetes mellitus (DM) have been reported to be an important predictor of poor functional outcome in patients experiencing acute ischemic stroke (AIS). However, conclusions of recent studies are inconsistent about which AGM status increases the risk of post-thrombolysis early neurological deterioration (END). The purpose of this study was to evaluate the impact of AGM status on the risk of post-thrombolysis early neurological outcomes. We further investigated the influence of previous glucose control of diabetic patients on the post-thrombolysis early neurological outcomes evaluation. Methods: Prediabetes was identified as glycosylated hemoglobin (HbAlc) (%) level within the range of 5.7%-6.4%, and diabetes mellitus (DM) was diagnosed based on prior history of diabetes or an HbAlc≥6.5% and patients with HbAlc less than 5.7% were classified as normal glucose metabolism (NGM). Diabetic patients with good PGC had HbAlc <7%, diabetic patients with poor PGC had HbAlc≥7%. END was defined as a National Institutes of Health Stroke Scale Score (NIHSS) ≥ 4, ENI was defined as a ≥4-point decrease in NIHSS score or a complete resolution of neurological deficits, between the time of admission and 24 hours after IV-rtPA. Results In total, 261 (32.7%) patients were diagnosed with prediabetes, 91 (11.4%) patients were DM had good PGC and 186 (23.3%) patients were DM had poor PGC. After adjusted for confounders, in model 1, DM with poor PGC associated with the increased risk of post-thrombolysis END and poor functional outcome at discharge (OR, 2.09; 95% CI, 1.220-3.579; P=0.007) (OR, 1.91; 95% CI, 1.165-3.133; P=0.010), both prediabetes and DM with poor PGC were less likely to experience post-thrombolysis ENI (OR, 0.58; 95% CI, 0.377-0.907; P=0.016) (OR, 0.43; 95% CI, 0.255-0.71; P=0.001); in model 2, further adjusted for admission hyperglycemia, the presence of diabetes and DM with poor PGC was still independently related to post-thrombolysis ENI (OR, 0.62; 95% CI, 0.400-0.969; P=0.036) (OR, 0.51; 95% CI, 0.282-0.923; P=0.026). Conclusion Prediabetes and DM with poor PGC might be two abnormal blood glucose metabolism states that affects post-thrombolysis early neurological outcome in AIS patients.

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Impact of Stress Hyperglycemia on Early Neurological Deterioration in Acute Ischemic Stroke Patients Treated With Intravenous Thrombolysis

Cited by 24 publications

References 36 publications

Analysis of influencing factors of early neurological improvement after intravenous rt-PA thrombolysis in acute anterior circulation ischemic stroke

Analysis of influencing factors of early neurological improvement after intravenous rt-PA thrombolysis in acute anterior circulation ischemic stroke

Association of the stress hyperglycemia ratio and clinical outcomes in patients with stroke: A systematic review and meta-analysis

Impact of abnormal glucose metabolism on the early neurological outcome in acute ischemic stroke patients treated with intravenous thrombolysis

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