The Stress Hyperglycemia Ratio is Associated with Hemorrhagic Transformation in Patients with Acute Ischemic Stroke

Yuan, Chunping; Chen, Siyan; Ruan, Yiting; Liu, Yuntao; Cheng, Haoran; Zeng, Yuxiao; Chen, Yunbin; Cheng, Qingyuan; Huang, Guiqian; He, Weilei; He, Jincai

doi:10.2147/cia.s280808

Cited by 58 publications

(54 citation statements)

References 53 publications

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“…However, Hempe et al (2010) pointed out that the term “eAG” should be used carefully for clinical practice due to discrepancies between eAG and self-monitored mean blood glucose. Another definition of SHR using the glucose/HbA1c ratio was more practical and widely applied in many studies ( Zhu et al, 2019 ; Li et al, 2020 ; Merlino et al, 2020 ; Yuan et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Admission Random Blood Glucose, Fasting Blood Glucose, Stress Hyperglycemia Ratio, and Functional Outcomes in Patients With Acute Ischemic Stroke Treated With Intravenous Thrombolysis

Chen

Ren

Huang

et al. 2022

Front. Aging Neurosci.

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BackgroundStress hyperglycemia ratio (SHR), calculated as glucose/glycated hemoglobin, has recently been developed for assessing stress hyperglycemia and could provide prognostic information for various diseases. However, calculating SHR using random blood glucose (RBG) drawn on admission or fasting blood glucose (FBG) could lead to different results. This study intends to evaluate the association between SHR and functional outcomes in patients with acute ischemic stroke (AIS) with recombinant tissue plasminogen activator (r-tPA) intravenous thrombolysis.MethodsData from 230 patients with AIS following thrombolytic therapy with r-tPA in the Third Affiliated Hospital of Wenzhou Medical University from April 2016 to April 2019 were retrospectively reviewed. SHR1 was defined as [RBG (mmol/L)]/[HbA1c (%)] and SHR2 was defined as [FBG (mmol/L)]/[HbA1c (%)]. The outcomes included early neurological improvement (ENI), poor function defined as a modified Rankin Scale score (mRS) of 3–6, and all-cause death in 3 months. Multivariable logistic regression was performed to estimate the association between SHR and adverse outcomes.ResultsAfter adjustment for possible confounders, though patients with AIS with higher SHR1 tend to have a higher risk of poor outcome and death and unlikely to develop ENI, these did not reach the statistical significance. In contrast, SHR2 was independently associated with poor functional outcome (per 0.1-point increases: odds ratios (OR) = 1.383 95% CI [1.147–1.668]). Further adjusted for body mass index (BMI), triglyceride-glucose index (TyG), and diabetes slightly strengthen the association between SHR (both 1 and 2) and adverse outcomes. In subgroup analysis, elevated SHR1 is associated with poor functional outcomes (per 0.1-point increases: OR = 1.246 95% CI [1.041–1.492]) in non-diabetic individuals and the association between SHR2 and the poor outcomes was attenuated in non-cardioembolic AIS.ConclusionSHR is expected to replace random or fasting glucose concentration as a novel generation of prognostic indicator and a potential therapeutic target.

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Section: Introductionmentioning

confidence: 99%

Admission Random Blood Glucose, Fasting Blood Glucose, Stress Hyperglycemia Ratio, and Functional Outcomes in Patients With Acute Ischemic Stroke Treated With Intravenous Thrombolysis

Chen

Ren

Huang

et al. 2022

Front. Aging Neurosci.

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“…Under acute stress, the stress-induced hyperglycemia is a common physiological response that usually refers to transient hyperglycemia (Yuan et al 2021). In the population, stress-induced hyperglycemia occurs in approximately half of patients with acute ischemic stroke, and it is generally believed to be associated with an increased risk of death and poor neurological prognosis (Li et al 2020).…”

Section: Discussionmentioning

confidence: 99%

RNA-seq analysis of ischemia stroke and normal brain in a tree shrew model with or without type 2 diabetes mellitus

et al. 2021

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Background: Nowadays, similar strategies have been used for the treatment and prevention of acute stroke in both diabetes mellitus (DM) and non-DM populations. These strategies were analyzed to provide an experimental basis for the clinical prevention and treatment of stroke in patients both with and without DM. Methods: Tree shrews were randomly divided into control, DM, ischemic stroke (IS), and DMIS groups with 18 animals in each group. Serum biochemical indicators were used to assess metabolic status. Neural tissue damage was determined using triphenyl tetrazolium chloride staining, H-E staining, and electron microscopy. Differential gene expression of neural tissue between the DM and control groups and the IS and DMIS groups was measured using RNA-seq analysis.Results: The serum glucose levels of the DM and DMIS groups were signi cantly higher than other groups.In the DMIS group, the infarct size was signi cantly larger than in the IS group (19.56 ± 1.25%), with a more obvious abnormal ultrastructure of neural cells. RNA-seq analysis showed that the expression of IL-8, C-C motif chemokine 2 (CCL2), and alpha-1-antichymotrypsin was signi cantly higher in the DM group than in the control group. The CCL7, ATP-binding cassette sub-family A member 12, and adhesion G protein-coupled receptor E2 levels were signi cantly higher in the DMIS group than in the IS group.Conclusions: For the prevention and treatment of stroke in patients with DM, reducing the in ammatory state of the nervous system may reduce the incidence of stroke and improve the prognosis of neurological function after IS.

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“…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 ]. Another study conducted on 287 patients from the First Affiliated Hospital of Wenzhou Medical University showed that a high stress hyperglycemia ratio (fasting blood sugar divided by HbA1c) was significantly associated with an increased risk of hemorrhagic transformation in patients with ischemic stroke [ 15 ].…”

Section: Discussionmentioning

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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The Stress Hyperglycemia Ratio is Associated with Hemorrhagic Transformation in Patients with Acute Ischemic Stroke

Cited by 58 publications

References 53 publications

Admission Random Blood Glucose, Fasting Blood Glucose, Stress Hyperglycemia Ratio, and Functional Outcomes in Patients With Acute Ischemic Stroke Treated With Intravenous Thrombolysis

Admission Random Blood Glucose, Fasting Blood Glucose, Stress Hyperglycemia Ratio, and Functional Outcomes in Patients With Acute Ischemic Stroke Treated With Intravenous Thrombolysis

RNA-seq analysis of ischemia stroke and normal brain in a tree shrew model with or without type 2 diabetes mellitus

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

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