Increased Postoperative Fasting Glucose Is Associated With Unfavorable Outcomes in Patients Treated With Mechanical Thrombectomy Treatment

Shi, Zongjie; Guo, Shunyuan; Pan, Jie; Xu, Chao; Yang, Geng; Zheng, Sujie

doi:10.3389/fneur.2021.668363

Cited by 9 publications

(10 citation statements)

References 32 publications

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“…Hyperglycemia is a common and essential therapeutic target in acute ischemic stroke with and without premorbid diabetes. 1 , 2 Recent studies found the variability of glucose after stroke onset, or mentioned as glucose fluctuation, was an independent risk factor for poor outcomes as well as the glucose level, 3–6 with underlying mechanisms including increased oxidative stress, aggravated inflammation, endothelial impairment and microcirculation dysfunction. 6–8 It is also recommended to avoid glycemic excessive fluctuation or hypoglycemia in patients with acute ischemic stroke.…”

Section: Introductionmentioning

confidence: 99%

Continuous Intravenous versus Subcutaneous Administration of Insulin for Glycemic Variability in Acute Ischemic Stroke

Du¹,

Liu²,

Ge³

et al. 2022

NDT

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Background Continuous intravenous infusion (IV) or subcutaneous injection (SC) of insulin was widely applied to control hyperglycemia after ischemic stroke. However, the impact of different administration modes on glycemic variability was unknown. Methods Consecutive stroke patients treated with intravenous thrombolysis were screened. Subjects who received insulin treatment were included and entered into the IV or SC group according to the respective administration mode. Blood glucose was closely monitored within the first 72 hours, and the target range of glucose was from 7.7 to 10.0 mmol/L for all patients. The variabilities of glucose, assessed using standard deviation of the mean, variable coefficient and range from the maximum to the minimum value, were compared between the two groups. Results A total of 130 patients were enrolled with 66 in the IV groups and 64 in the SC group. Compared with the SC group, the IV group had higher glycemic variability evaluated as either standard deviation (2.7 ± 0.7 mmol/L vs 2.2 ± 0.9 mmol/L, p = 0.002), variable coefficient (0.26 ± 0.06 vs 0.23 ± 0.08, p = 0.011) or range (10.0 ± 3.6 mmol/L vs 8.1 ± 3.1 mmol/L, p = 0.001). Multivariate logistic regression analyses found that continuous intravenous infusion was associated with higher level of the standard deviation (adjusted OR 3.01, 95% CI 1.29–7.28, p = 0.011), variable coefficient (adjusted OR 5.97, 95% CI 2.55–13.96, p < 0.001) and range (adjusted OR 6.08, 95% CI 2.63–14.05, p < 0.001). Conclusion Continuous intravenous infusion of insulin was associated with higher glycemic variability than subcutaneous injection in acute stroke patients receiving thrombolysis.

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Section: Introductionmentioning

confidence: 99%

Continuous Intravenous versus Subcutaneous Administration of Insulin for Glycemic Variability in Acute Ischemic Stroke

Du¹,

Liu²,

Ge³

et al. 2022

NDT

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“…The combined findings of a shorter onset to puncture time, shorter procedure times, and a higher rate of successful recanalization in the EM+ group indicate that a pre-existing non-disabling EM may impact the patient benefit from the EVT. Older age (18,19) and higher systolic blood pressure on admission (20,21) in the EM+ group may in part contribute to the unfavorable outcomes. Also, we hypothesize that the structural and functional changes caused by the contralateral EM, combined with the responsible focus for index stroke, may damage the bilateral brain tissues and may impair the reserve and recovery capacity.…”

Section: Discussionmentioning

confidence: 98%

Pre-Existing Non-Disabling Encephalomalacia Confers Risk to Stroke Outcomes After Endovascular Treatment

et al. 2022

Front. Neurol.

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BackgroundPatients with previous stroke episodes tend to have poor outcomes after an endovascular treatment (EVT). Encephalomalacia (EM) is an objective indicator of previous strokes but has not been systematically investigated. The fundamental aim of this exploration is to investigate the effects of a pre-existing non-disabling EM on clinical outcomes after EVT.MethodsConsecutive patients undergoing an EVT due to the anterior circulation large vessel occlusion (LVO) strokes were enrolled in the study. The pre-existing EM was defined as the focal hypodense lesions (≥ 3 mm in maximum diameter) on a non-contrast cranial CT using axial images before EVT. The primary outcome was the 90-day functional assessment using the modified Rankin Scale (mRS) score. The safety outcome was the incidence of symptomatic intracranial hemorrhage (sICH) defined as any hemorrhage within 24 h after an EVT, which is responsible for an increase of ≥ 4 points in the score of National Institutes of Health Stroke Scale (NIHSS).ResultsOf the 433 patients analyzed in this investigation, a pre-existing non-disabling EM was observed in 106 (24.5%) patients. After adjusting for potential confounding factors, patients with contralateral EM (OR = 2.68, 95% CI = 1.13–6.31; P = 0.025) and with an EM+ > 20 mm in maximum diameter (OR = 2.21, 95% CI = 1.01–4.85; P =0.048) were substantially associated with unfavorable outcomes (mRS > 2). For the sICH, we did not observe any association with the pre-existing EM (P > 0.05).ConclusionsA pre-existing non-disabling EM is common and safe in patients undergoing EVT. However, a contralateral EM and the large size of EM may predict an unfavorable outcome at 90 days, which should receive more attention before EVT.

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“…Nevertheless, random blood glucose is susceptible to a variety of factors, like intake of food rich in sugar and medicine like hypoglycemic agents [ 9 ] et al Fasting blood glucose is less affected by food and drugs and almost every patient was tested after admission. FBG could partly reflect stress response resulting from the interaction of hormones with concomitant insulin resistance during acute diseases [ 9 , 25 ]. To some extent, it could reflect the influence of EVT on blood glucose.…”

Section: Discussionmentioning

confidence: 99%

“…To some extent, it could reflect the influence of EVT on blood glucose. Only a few studies indicate that increased fasting blood glucose rises the risk of adverse functional outcome after EVT [ 7 , 8 , 9 , 25 ]. A retrospective cohort study found that there was a shift towards worse functional outcome in patients with increased fasting glucose levels, and impaired fasting glucose (glucose level above 5.5 mmol/L) was associated with poor functional outcome or death and with sICH during hospitalization [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we also established a nomogram for nondiabetics, which showed better discrimination with C-index of 0.855 than the nomogram for all patients. The potential mechanisms of glycemia increase on poor functional outcome may attributed to several aspects, such us altered mitochondrial function, disrupted blood–brain barrier, increased oxidative stress response, impaired cerebrovascular reactivity, and exacerbated ischemic brain injury, among others [ 7 , 9 , 25 , 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

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A Glycemia-Based Nomogram for Predicting Outcome in Stroke Patients after Endovascular Treatment

Liu¹,

Zhang²,

Li³

et al. 2022

Brain Sciences

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Higher fasting glucose is thought to be associated with adverse outcome in patients receiving endovascular treatment (EVT), while the effect of glycosylated hemoglobin (HbA1c) on outcome is controversial. We combined fasting blood glucose (FBG) with HbA1c and evaluated their relationship with the three-month functional outcome in patients who underwent EVT. Methods: Data from 739 consecutive ischemic stroke patients who underwent EVT from April 2015 to August 2021 were retrospectively reviewed. HbA1c was used to estimate the chronic glucose level according to the following formula: chronic glucose level (mg/dL) = 28.7 × HbA1c (%) − 6.7. Patients were split into two groups in accordance with the three-month modified Rankin Scale (mRS). Univariate and multivariate analyses were utilized to investigate the association of outcome with blood glucose and to identify other predictors of prognosis. Results: Patients with poor outcome had significantly higher FBG, chronic glycemia, FBG/chronic glycemic ratio, and difference between FBG and chronic glycemia (ΔA–C). FBG, the FBG/chronic glycemic ratio, and ΔA-C remained to be associated with poor outcome after adjustment. We then established a glycemia-based nomogram with a concordance index of 0.841, and it showed favorable clinical utility according to decision curve analysis. Conclusions: Glycemia after EVT was connected with the functional outcome and a nomogram based on glycemia may be used to predict prognosis in stroke patients treated with EVT.

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Increased Postoperative Fasting Glucose Is Associated With Unfavorable Outcomes in Patients Treated With Mechanical Thrombectomy Treatment

Cited by 9 publications

References 32 publications

Continuous Intravenous versus Subcutaneous Administration of Insulin for Glycemic Variability in Acute Ischemic Stroke

Continuous Intravenous versus Subcutaneous Administration of Insulin for Glycemic Variability in Acute Ischemic Stroke

Pre-Existing Non-Disabling Encephalomalacia Confers Risk to Stroke Outcomes After Endovascular Treatment

A Glycemia-Based Nomogram for Predicting Outcome in Stroke Patients after Endovascular Treatment

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