Comparison of admission random glucose, fasting glucose, and glycated hemoglobin in predicting the neurological outcome of acute ischemic stroke: a retrospective study.

Jia-Ying Sung,Han-Hwa Hu,Hung-Yi Chiou,Hsin-Chiao Wu,Lung Chan,Yi-Chen Hsieh,Nai-Fang Chi,Chin-I Chen,Chaur-Jong Hu,Yih-Ru Chen

doi:10.7717/peerj.2948

Abstract

BackgroundHyperglycemia is a known predictor of negative outcomes in stroke. Several glycemic measures, including admission random glucose, fasting glucose, and glycated hemoglobin (HbA1c), have been associated with bad neurological outcomes in acute ischemic stroke, particularly in nondiabetic patients. However, the predictive power of these glycemic measures is yet to be investigated.MethodsThis retrospective study enrolled 484 patients with acute ischemic stroke from January 2009 to March 2013, and complete records of initial stroke severity, neurological outcomes at three months, and glycemic measures were evaluated. We examined the predictive power of admission random glucose, fasting glucose, and HbA1c for neurological outcomes in acute ischemic stroke. Furthermore, subgroup analyses of nondiabetic patients and patients with diabetes were performed separately.ResultsReceiver operating characteristic (ROC) analysis revealed that admission random glucose and fasting glucose were significant predictors of poor neurological outcomes, whereas HbA1c was not (areas under the ROC curve (AUCs): admission random glucose = 0.564, p = 0.026; fasting glucose = 0.598, p = 0.001; HbA1c = 0.510, p = 0.742). Subgroup analyses of nondiabetic patients and those with diabetes revealed that only fasting glucose predicts neurological outcomes in patients with diabetes, and the AUCs of these three glycemic measures did not differ between the two groups. A multivariate logistic regression analysis of the study patients indicated that only age, initial stroke severity, and fasting glucose were independent predictors of poor neurological outcomes, whereas admission random glucose and HbA1c were not (adjusted odds ratio: admission random glucose = 1.002, p = 0.228; fasting glucose = 1.005, p = 0.039; HbA1c = 1.160, p = 0.076). Furthermore, subgroup multivariate logistic regression analyses of nondiabetic patients and those with diabetes indicated that none of the three glycemic measures were associated with poor neurological outcomes.DiscussionFasting glucose is an independent predictor of poor neurological outcomes in patients with acute ischemic stroke and had greater predictive power than that of admission random glucose and HbA1c. The predictive power of glycemic measures for poor neurological outcomes did not differ significantly between the nondiabetic patients and those with diabetes.

Highlights

Hyperglycemia may be present in more than half of patients with acute ischemic stroke (Scott et al, 1999)
Receiver operating characteristic (ROC) analysis revealed that admission random glucose was a predictor of poor neurological outcomes in all study patients; it was not associated with poor neurological outcomes in the logistic regression analysis
Studies have reported that a high level of fasting or random glucose is associated with poor neurological outcomes or mortality in acute ischemic stroke (Capes et al, 2001; Fang et al, 2013; Hu et al, 2012), and hyperglycemia at the acute stage of the disease may be largely caused by stress (Douketis, 2002)

Summary

Introduction

Hyperglycemia may be present in more than half of patients with acute ischemic stroke (Scott et al, 1999). Some studies have reported that in acute ischemic stroke, hyperglycemia is more detrimental in nondiabetic patients than in those with diabetes (Capes et al, 2001; Stead et al, 2009; Yao et al, 2016) These glycemic measures have been associated with neurological outcomes in acute ischemic stroke, the most predictive factor among these is yet to be reported. The present study compared the predictive performance of admission random glucose, fasting glucose, and HbA1c for poor neurological outcomes in acute ischemic stroke. Several glycemic measures, including admission random glucose, fasting glucose, and glycated hemoglobin (HbA1c), have been associated with bad neurological outcomes in acute ischemic stroke, in nondiabetic patients. Subgroup multivariate logistic regression analyses of nondiabetic patients and those with diabetes indicated

Methods

Results

Conclusion