GLYCEMIC VARIABILITY IN ACUTE ISCHEMIC STROKE AND COGNITIVE OUTCOME

Abstract

Post-stroke cognitive impairment (PSCI) is one of the major burdens for stroke survivors. Poorly controlled hyperglycemia and hypoglycemic events are well-known predictors for cognitive impairment. We aimed to investigate the effect of glycemic variability in the acute stroke on the development of PSCI. Patients hospitalized with acute ischemic stroke in a university hospital were enrolled. Blood glucose levels were queried using clinical database warehouse in electronic medical records, and patients with at least 5 times blood glucose levels within 7 days after stroke onset were included. Glycemic variability variables – standard deviation (SD), coefficients of variances (CVs% = SD/mean * 100), mean absolute glucose (MAG, ∑|ΔGlucose|/∑ΔTime) – were calculated. Detailed neuropsychological assessments were administered at 3 to 6 months after stroke. Primary outcome was the occurrence of PSCI, which was defined as a score of less than -2 SD for age-, sex-, and education-adjusted mean in at least one cognitive domain. Odds ratios were calculated using multiple logistic regression analysis. A total of 361 patients were enrolled. (mean age 63.1±12.0, median score of initial National Institutes of Health Stroke Scale 2, median number of blood glucose evaluations 14). Diabetes mellitus was observed in 88 (24.4%) patients. PSCI was developed in 80 (22.2%) patients, and those with PSCI were significant older, and more likely to be female, and had more severe stroke compared to those without PSCI. There were no significant differences in the proportion of patients with diabetes mellitus or in mean values of HbA1c according to 3-month cognitive outcome. In diabetic group, SD and MAG have been identified as significant predictors for PSCI (adjusted OR for SD 1.81, 95% CI 1.04–3.16; adjusted OR for MAG 1.94, 95% CI 1.14–3.29). Meanwhile, SD and MAG showed martial significances in non-diabetic group, though the PSCI had an increasing tendency along the higher tertiles of SD and MAG. Glycemic variability during acute ischemic stroke was identified as novel predictor for PSCI. As the modifiable risk factor for PSCI, glycemic variability might be considered as an important monitoring parameter and treatment target in acute stroke.