Abstract
BackgroundThe relationship between baseline fasting blood glucose (FBG) levels and 1-year stroke recurrence in non-diabetic patients with acute cerebral infarction (ACI) is unclear. We aimed to clarify this relationship in non-diabetic patients with ACI.MethodsBaseline FBG levels and related information of the patients were collected at admission and the events of stroke recurrence were followed up 1, 3, 6, and 12 months after the patients were discharged. Baseline FBG levels were analyzed as continuous variables and quartiles (Q1–Q4). Multivariate Cox regression models and a two-piecewise linear regression model were used to investigate the relationship and determine the threshold effect between baseline FBG levels and 1-year stroke recurrence in non-diabetic patients with ACI.ResultsOverall, 1,634 non-diabetic patients with ACI were enrolled. After adjusting for potential confounding factors, the hazard is 2.24-fold higher in Q4 than those in Q2, being considered the reference in non-diabetic patients with ACI [hazard ratio (HR) = 2.24, 95%CI: 1.08–4.65, P = 0.031]. Plotting hazard ratios over baseline FBG levels suggested a J-shaped relationship for 1-year stroke recurrence. Further analysis revealed that the nadir value of baseline FBG levels is 4.6 mmol/L. The relationship was more significant in patients with atrial fibrillation than in those without (P for interaction = 0.009).ConclusionLower and higher baseline FBG levels may lead to an increased risk of 1-year stroke recurrence in non-diabetic patients with ACI as shown by a J-shaped curve with a nadir value of 4.6 mmol/L.
Highlights
Acute cerebral infarction (ACI) is the most common type of stroke, accounting for higher than 70% of all strokes
After adjusting for potential confounding factors, the hazard is 2.24-fold higher in Q4 than those in Q2, which was considered the reference in non-diabetic patients with ACI (HR = 2.24, 95%confidence intervals (CIs): 1.08–4.65, P = 0.031; Table 2)
Similar results were found for patients without pneumonia (HR = 2.52, 95%CI: 1.09–5.8) and without previous stroke (HR = 3.57, 95%CI: 1.17–10.9) but not significant in interactive analyses. In this multicenter cohort study, we found that either lower or higher levels of baseline fasting blood glucose (FBG) were associated with an elevated risk of 1-year stroke recurrence, and the relationship between them presented as a J-shaped curve with a baseline FBG nadir value of 4.6 Mild Moderate Severe Laboratory findings Total cholesterol (mmol/L) in non-diabetic patients with ACI in Xi’an area
Summary
Acute cerebral infarction (ACI) is the most common type of stroke, accounting for higher than 70% of all strokes. It is the second leading cause of death worldwide and the leading cause of death and disability-adjusted life-years in China [1,2,3]. Previous studies showed that hyperglycemia occurs in 30– 40% of patients with acute ischemic stroke Most of these patients do not have a known history of diabetes [4,5,6]. The relationship between baseline fasting blood glucose (FBG) levels and 1-year stroke recurrence in non-diabetic patients with acute cerebral infarction (ACI) is unclear. We aimed to clarify this relationship in non-diabetic patients with ACI
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