Impacts of stress hyperglycemia ratio on early neurological deterioration and functional outcome after endovascular treatment in patients with acute ischemic stroke

Zheng, Dong; Cao, Haiming; Wang, Rui; Li, Lei; Guo, Hua; Zhang, Xiaohao; Jiang, Hanchao; Zhu, Juehua; Jiang, Yanrui; Liu, Dezhi; Xu, Gelin

doi:10.3389/fendo.2023.1094353

Cited by 15 publications

(3 citation statements)

References 36 publications

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“…36 Similarly, a multi-center randomized controlled trial yielded comparable results by revealing no significant difference in 90-day mortality rates among patients without preexisting diabetes who developed hyperglycemia within 24 h of admission. 37,38 Other studies have likewise supported these findings, suggesting that meticulous blood glucose management through insulin administration during stroke does not improve the outcome or reduce mortality for patients with acute ischemic stroke; instead, it appears to heighten the risk of hypoglycemia. 39 The relationship between stress-induced hyperglycemia and stroke remains inconclusive, a situation possibly arising from the subsequent factors: ① Variation in Diagnostic Criteria: A substantial disparity exists in the diagnostic criteria for stressinduced hyperglycemia across various studies.…”

Section: Discussionmentioning

confidence: 96%

Effect of admission serum glucose on the clinical prognosis of patients with acute ischemic stroke receiving alteplase intravenous thrombolysis

Huang,

2023

Int J Immunopathol Pharmacol

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Objective: To investigate the effect of admission serum glucose on the clinical prognosis of patients with acute ischemic stroke receiving intravenous alteplase thrombolysis. Methods: Patients with acute ischemic stroke who received intravenous alteplase thrombolysis between January 2016 and December 2017 were enrolled. The clinical prognosis was assessed using the modified Rankin Scale (mRs) at 90 days after onset. Univariate and multivariate logistic regression analyses were conducted to investigate whether admission serum glucose was an independent factor in the 90-day prognosis. The predictive value of admission serum glucose for a 90-day poor prognosis was evaluated using receiver operating characteristic (ROC) curves. All patients were divided into two groups based on admission serum glucose levels: high admission serum glucose (above the cut-off value) and low admission serum glucose (below the cut-off value). The 90-day prognosis of patients with different admission serum glucose was analyzed. Results: A total of 138 patients were enrolled, including 79 males (57.24%), with a mean age of (68 ± 12) years and a median baseline National Institutes of Health Stroke Scale (NIHSS) score of 9 (6 to 13.75). There were 74 cases (53.62%) in the good prognosis group and 64 cases (46.37%) in the poor prognosis group. The results of the univariate analysis indicated that admission serum glucose in the good prognosis group was significantly lower than that in the poor prognosis group [(7.45 ± 2.31) versus (8.80 ± 3.65), p < .05]. Logistic regression analysis revealed that the admission serum glucose level was an independent risk factor for clinical prognosis at 90 days after onset (OR = 1.24, 95% CI:1.01–1.52). ROC curve analysis showed that the cutoff value of admission serum glucose for predicting poor prognosis 90 days after intravenous thrombolytic therapy with alteplase was 6.77 mmol/l AUC (area under curve) 0.623, 95%CI: 0.53–0.72, sensitivity 68.80%, specificity 52.70%. When compared with the admission serum glucose ≥6.77 mmol/l group (83 cases), the 90-day mRS scores in the admission serum glucose <6.77 mmol/l group (55 cases) were lower [3 (1 to 5) scores versus 1 (0 to 3) scores, Z = 2.89, p < .05]. Conclusions: In patients with acute ischemic stroke receiving intravenous alteplase thrombolytic therapy, a higher admission serum glucose level is an independent predictor of adverse neurological outcomes at 90 days postoperatively.

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Section: Discussionmentioning

confidence: 96%

Effect of admission serum glucose on the clinical prognosis of patients with acute ischemic stroke receiving alteplase intravenous thrombolysis

Huang,

2023

Int J Immunopathol Pharmacol

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“…By introducing HbA1c, the SHR, an index of relative glycemia, was developed in an effort to obtain new insights into the relationship between hyperglycemia and patient outcomes. Previous studies had demonstrated that the strong relationship between SHR and poor clinical outcomes in acute coronary syndrome ( 33 – 36 ), acute ischemic stroke ( 13 , 37 ), heart failure and type 2 DM ( 38 ). Our study also demonstrated the strong association between SHR and mortality in cardiac arrest patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of stress hyperglycemia ratio on mortality in patients with cardiac arrest: insight from American MIMIC-IV database

Lian,

Xue,

et al. 2024

Front. Endocrinol.

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BackgroundStress hyperglycemia ratio (SHR) has shown a predominant correlation with transient adverse events in critically ill patients. However, there remains a gap in comprehensive research regarding the association between SHR and mortality among patients experiencing cardiac arrest and admitted to the intensive care unit (ICU).MethodsA total of 535 patients with their initial ICU admission suffered cardiac arrest, according to the American Medical Information Mart for Intensive Care (MIMIC)-IV database. Patients were stratified into four categories based on quantiles of SHR. Multivariable Cox regression models were used to evaluate the association SHR and mortality. The association between SHR and mortality was assessed using multivariable Cox regression models. Subgroup analyses were conducted to determine whether SHR influenced ICU, 1-year, and long-term all-cause mortality in subgroups stratified according to diabetes status.ResultsPatients with higher SHR, when compared to the reference quartile 1 group, exhibited a greater risk of ICU mortality (adjusted hazard ratio [aHR] = 3.029; 95% CI: 1.802-5.090), 1-year mortality (aHR = 3.057; 95% CI: 1.885-4.958), and long-term mortality (aHR = 3.183; 95% CI: 2.020-5.015). This association was particularly noteworthy among patients without diabetes, as indicated by subgroup analysis.ConclusionElevated SHR was notably associated with heightened risks of ICU, 1-year, and long-term all-cause mortality among cardiac arrest patients. These findings underscore the importance of considering SHR as a potential prognostic factor in the critical care management of cardiac arrest patients, warranting further investigation and clinical attention.

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“…This stress state can aggravate the progression of stroke disease, aggravate the damage and edema of the patient's brain tissue, expand the infarct size, and further increase disability and mortality. Stress hyperglycemia ratio (SHR) indicator considering both glucose and HbA1C to quantify this stress condition 7 . The degree of stress hyperglycemia can be accurately identified and quantified, and the predictive value of SHR is better than other indicators 8 .…”

Section: Introductionmentioning

confidence: 99%

Association between Stress Hyperglycemia Ratio and Functional Outcomes in Patients with Acute Ischemic Stroke

Xiao,

Gao,

et al. 2024

Preprint

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Objective: This study aimed to evaluate the association between stress hyperglycemia ratio (SHR) and poor functional outcomes at 90 days in patients with acute ischemic stroke (AIS). Methods: Retrospective collection of 1988 patients with AIS admitted to two hospitals in the Shenzhen area between January 2022 and March 2023. A total of 1255 patients with Fasting Blood-glucose (FBG) and hemoglobin A1c (HbA1C) values at admission were included in this analysis. SHR, measured by FBG/HbA1C, was evaluated as both a tri-categorical variable (Tertile 1: ≤0.83; Tertile 2: 0.84 -0.95; Tertile 3: ≥0.96). The outcome was poor functional outcomes (modified Rankin Scale [mRS] score 2-6) at 90 days. We performed univariate analysis, multiple equation regression analysis, stratified analysis, and interactive analysis. Results: Compared with patients in the lowest tertile of SHR, the highest tertile group had significantly lower odds of achieving poor functional outcomes (adjusted odds ratio, OR=2.84, 95% CI: 2.02-3.99, P<0.0001) at 90 days after adjusting for potential covariates. Similar results were observed after further adjustment for white blood cell count, neutrophil count, lymphocyte count, fasting blood glucose, stroke type, intravenous thrombolytic therapy, baseline Glasgow score, and baseline NIHSS score. Conclusion: Stress hyperglycemia ratio, as measured by the FBG/HbA1C, was associated with an increased odds of achieving poor functional outcomes in patients with AIS at 90 days.

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Impacts of stress hyperglycemia ratio on early neurological deterioration and functional outcome after endovascular treatment in patients with acute ischemic stroke

Cited by 15 publications

References 36 publications

Effect of admission serum glucose on the clinical prognosis of patients with acute ischemic stroke receiving alteplase intravenous thrombolysis

Effect of admission serum glucose on the clinical prognosis of patients with acute ischemic stroke receiving alteplase intravenous thrombolysis

Impact of stress hyperglycemia ratio on mortality in patients with cardiac arrest: insight from American MIMIC-IV database

Association between Stress Hyperglycemia Ratio and Functional Outcomes in Patients with Acute Ischemic Stroke

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