Abstract
Background and ObjectiveStress hyperglycemia may occur in diabetic patients with acute severe cerebrovascular disease, but the results regarding its association with stroke outcomes are conflicting. This study aimed to examine the association between stress‐induced hyperglycemia and the occurrence of in‐hospital death in patients with diabetes and acute ischemic stroke.Research Design and MethodsAll data were from the Chinese Stroke Center Alliance (CSCA) database and were collected between 2016 and 2018 from >300 centers across China. Patients’ demographics, clinical presentation, and laboratory data were extracted from the database. The primary endpoint was in‐hospital death. The ratio of fasting blood glucose (FBG) to HbA1c was calculated, that is, the stress‐induced hyperglycemia ratio (SHR), to determine stress hyperglycemia following acute ischemic stroke.ResultsA total of 168,381 patients were included. The mean age was 66.2 ± 10.7, and 77,688 (43.0%) patients were female. The patients were divided into two groups: survivors (n = 167,499) and non‐survivors (n = 882), as well as into four groups according to their SHR quartiles (n = 42,090–42,099/quartile). There were 109 (0.26%), 142 (0.34%), 196 (0.47%), and 435 (1.03%) patients who died in the Q1, Q2, Q3, and Q4 quartiles, respectively. Compared with Q1 patients, the death risk was higher in Q4 patients (odds ratio (OR) = 4.02) (adjusted OR = 1.80, 95% confidence interval [CI] = 1.10–2.92, p = 0.018 after adjustment for traditional cardiovascular risk factors). The ROC analyses showed that SHR (AUC = 0.667, 95% CI: 0.647–0.686) had a better predictive value for mortality than that of fasting blood glucose (AUC = 0.633, 95% CI: 0.613–0.652) and HbA1c (AUC = 0.523, 95% CI: 0.504–0.543).ConclusionsThe SHR may serve as an accessory parameter for the prognosis of patients with diabetes after acute ischemic stroke. Hyperglycemia in stroke patients with diabetes mellitus is associated with a higher risk of in‐hospital death.
Highlights
Background and ObjectiveStress hyperglycemia may occur in diabetic patients with acute severe cerebrovascular disease, but the results regarding its association with stroke outcomes are conflicting.Our study aimed to examine the association between stress-induced hyperglycemia and the occurrence of in-hospital death in patients with diabetes and acute ischemic stroke.Research Design and Methods: All data were from the Chinese Stroke Center Alliance (CSCA) database and were collected between 2016 and 2018 from > 300 centers across China
The stress-induced hyperglycemia ratio (SHR) may serve as an accessory parameter for the prognosis of patients with diabetes after acute ischemic stroke.Hyperglycemia in stroke patients with diabetes mellitus is associated with a higher risk of in-hospital death
A meta-analysis of stroke and hyperglycemia demonstrated that stress hyperglycemia in nondiabetic patients was associated with an increased risk of mortality after stroke (pooled relative risk (RR) = 3·07, 95% confidence index (CI): 2·50 − 3·79), but this was not observed in patients with a history of diabetes [6]
Summary
Background and ObjectiveStress hyperglycemia may occur in diabetic patients with acute severe cerebrovascular disease, but the results regarding its association with stroke outcomes are conflicting.Our study aimed to examine the association between stress-induced hyperglycemia and the occurrence of in-hospital death in patients with diabetes and acute ischemic stroke.Research Design and Methods: All data were from the Chinese Stroke Center Alliance (CSCA) database and were collected between 2016 and 2018 from > 300 centers across China. A meta-analysis of stroke and hyperglycemia demonstrated that stress hyperglycemia in nondiabetic patients was associated with an increased risk of mortality after stroke (pooled relative risk (RR) = 3·07, 95% confidence index (CI): 2·50 − 3·79), but this was not observed in patients with a history of diabetes [6] This phenomenon is supported by other cohort studies [4, 7] and was observed in other critical illnesses, i.e., that acute hyperglycemia with pre-existing diabetes mellitus led to lower mortality and shorter length of ICU stay than in patients without diabetes [6, 8, 9]. Most of the previous studies used fasting glucose or initial blood glucose to determine the presence of stress hyperglycemia, without considering the usual glucose levels before stroke onset This might explain why stress hyperglycemia cannot predict the outcome of stroke in patients with a history of diabetes. It takes into account glycated hemoglobin, which represents the blood glucose levels over the last 2–3 months, and random blood glucose after the stress events [10]
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