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

被引:20
|
作者
Wang, Ling [1 ]
Cheng, Qiantao [2 ,3 ]
Hu, Ting [4 ]
Wang, Nuo [1 ]
Wei, Xiu'e [4 ]
Wu, Tao [5 ]
Bi, Xiaoying [1 ]
机构
[1] Second Mil Med Univ, Changhai Hosp, Dept Neurol, Shanghai, Peoples R China
[2] Anhui Med Univ, Affiliated Hosp 4, Dept Neurol, Hefei, Peoples R China
[3] Nanjing Univ, Affiliated Drum Tower Hosp, Med Sch, Dept Neurol, Nanjing, Peoples R China
[4] Xuzhou Med Univ, Affiliated Hosp 2, Dept Neurol, Xuzhou, Peoples R China
[5] Second Mil Med Univ, Ctr Cerebrovascular Disorders, Dept Neurol, Shanghai, Peoples R China
来源
FRONTIERS IN NEUROLOGY | 2022年 / 13卷
关键词
acute ischemic stroke; stress hyperglycemia; early neurological deterioration; intravenous recombinant tissue-type plasminogen activator; stress hyperglycemia ratio; RELATIVE HYPERGLYCEMIA; OXIDATIVE STRESS; PREDICTORS; GLUCOSE; CLASSIFICATION; ACIDOSIS; EVENTS; RATIO;
D O I
10.3389/fneur.2022.870872
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and PurposeIt has been widely reported that stress hyperglycemia contributes to poor prognosis in patients experiencing acute ischemic stroke (AIS). However, its predictive value for early neurological deterioration (END) after intravenous administration of recombinant tissue-type plasminogen activator (IV-rtPA) in AIS patients is still unclear. The aim of this study was to evaluate the impact of stress hyperglycemia on the risk of END after IV-rtPA. MethodsA total of 798 consecutive patients treated with IV-rtPA were included in this study. The stress hyperglycemia ratio (SHR) was calculated as fasting plasma glucose level at admission (mg/dl)/glycosylated hemoglobin (HbAlc) (%). END was defined as a National Institutes of Health Stroke Scale Score (NIHSS) >= 4 points 24 h after IV-rtPA, and poor functional outcome at discharge was defined as a modified Rankin Scale (mRS) score of 3-6 at discharge. Patients with a prior history of diabetes or HbAlc >= 6.5% were considered to have diabetes mellitus. Patients were grouped according to SHR values. Multivariate logistical regression was used to evaluate the risk of END for patients within specific SHR categories. ResultsIn total, 139 (17.4%) patients had END. After adjusting for confounders, the highest tertile group had higher risks of END and poor functional outcome at discharge than those of patients in the lowest tertile group (OR, 1.95; 95% CI, 1.21-3.15; p = 0.006) (OR, 1.85; 95% CI, 1.163-2.941; p = 0.009), and the predictive value of high SHR for END was also significant in patients with diabetes mellitus (OR, 3.05; 95% CI, 1.29-7.21; p = 0.011). However, a significant association of high SHR and poor functional outcome was only found in patients without diabetes (OR, 1.85; 95% CI, 1.002-3.399; p = 0.045). ConclusionA higher SHR predicted that patients with severe stress hyperglycemia had higher risks of END and poor functional outcome at discharge after IV-rtPA.
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页数:8
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