Stress Hyperglycemia and Outcome of Non-diabetic Patients After Acute Ischemic Stroke

Bihong Zhu,Yongjun Wang,Xia Meng,Xingquan Zhao,Jing Jing,Yuesong Pan,Yilong Wang,Zhimin Wang,Liping Liu

doi:10.3389/fneur.2019.01003

Abstract

Background and Purpose: Stress hyperglycemia is relative hyperglycemia after suffering an acute illness such as stroke, even without preexisting diabetes. Our study aimed to determine the relationship between stress hyperglycemia and outcome of non-diabetic patients with acute ischemic stroke.Methods: Data were derived from the ACROSS-China (Abnormal Glucose Regulation in Patients with Acute Stroke across China) registry. Patients with ischemic stroke but without a history of diabetes mellitus were included in this analysis. Stress hyperglycemia was measured by glucose-to-glycated hemoglobin (HbA1c) ratio which was calculated by fasting plasma glucose (FPG) divided by HbA1c. We investigated the association between quartiles of glucose-to-HbA1c ratio and stroke recurrence and all-cause death at 12 months after stroke onset.Results: We included a total of 999 patients, among which there were 105 (10.9%) recurrent strokes and 76 (7.6%) deaths at 12 months. Using the lowest quartile of glucose-to-HbA1c ratio as the reference, patients with the highest quartile were associated with an increased risk of stroke recurrence [16.0 vs. 8.3%; adj.hazards ratio (HR) = 2.19, 95% confidence interval (CI): 1.26–3.83] and death (13.0 vs. 4.3%; adj.HR=2.86, 95%CI: 1.38–5.90) at 12 months after adjusted for potential covariates. We also observed that a higher level of glucose-to-HbA1c ratio was associated with an elevated risk of stroke recurrence and death.Conclusion: Stress hyperglycemia, measured by glucose-to-HbA1c ratio, was related to an elevated risk of stroke recurrence and all-cause death in patients with acute ischemic stroke but without diabetes.

Highlights

Stress hyperglycemia is different from various forms of diabetes mellitus and is common after suffering an acute illness such as myocardial infarction or stroke, even in the absence of preexisting diabetes [1,2,3]
Recent studies showed that relative hyperglycemia, defined as glucose-to-HbA1c ratio [6], or defined as admission glucose divided by estimated average glucose derived from HbA1c [2, 7], might be a better predicter of outcomes of critical illness than absolute hyperglycemia
We aimed to explore the relationship between stress hyperglycemia, which was measured by glucose-to-HbA1c ratio, and the outcome of non-diabetic patients with acute ischemic stroke in a prospective stroke registry study in China

Summary

Introduction

Stress hyperglycemia is different from various forms of diabetes mellitus and is common after suffering an acute illness such as myocardial infarction or stroke, even in the absence of preexisting diabetes [1,2,3]. Stress Hyperglycemia and Outcome of Stroke ischemic stroke in non-diabetic patients. Stress hyperglycemia was defined according to absolutely but not relatively increased fasting or random glucose in non-diabetic patients in most previous studies [3, 4]. The ratio of acute fasting plasma glucose (FPG) to HbA1c means the relative hyperglycemia, namely stress hyperglycemia. Stress hyperglycemia is relative hyperglycemia after suffering an acute illness such as stroke, even without preexisting diabetes. Our study aimed to determine the relationship between stress hyperglycemia and outcome of non-diabetic patients with acute ischemic stroke

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Conclusion