Gregory Roberts1,2, James Sires2, Angela Chen3, Tilenka Thynne2,4, Cheyne Sullivan1, Stephen Quinn5, Won Sun Chen5, Emily Meyer3,6. 1. SA Pharmacy, Flinders Medical Centre, Bedford Park, South Australia, Australia. 2. College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia. 3. Diabetes and Endocrine Services, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, Australia. 4. Department of Clinical Pharmacology, Flinders Medical Centre, Bedford Park, South Australia, Australia. 5. Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia. 6. Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Abstract
BACKGROUND: The aim of this study is to compare metrics specific for stress-induced hyperglycemia (SIH) with glucose for predicting ischemic stroke outcome. METHODS: This observational retrospective study (n = 300) included patients acutely hospitalized for ischemic stroke over a 3.8-year period. We assessed the association between acute ischemic stroke outcome with the stress hyperglycemia ratio (SHR, relative increase in glycemia) and glycemic gap (GG, absolute increase in glycemia) using admission values and 5-day maximum values, along with incidence of poor outcome above recognized clinical thresholds of glucose 10 mmol/L, SHR 1.14, and GG 2.5 mmol/L. RESULTS: At admission, only SHR was associated with outcome after adjustment for clinical covariates (odds ratio [OR] = 2.88; 95% CI: 1.05-7.91; P = .041), while glucose or GG were not. Admission SHR ≥ 1.14 was also an indicator of poor outcome (39.1% vs 23.4%, P = .016), but not glucose ≥10 mmol/L or GG ≥ 2.5 mmol/L. All 5-day maximum glucose metrics were associated with outcome, as was any SHR ≥ 1.14 (40.9% vs 20.1%, P < .001) or GG ≥ 2.5 mmol/L (42.9% vs 23.4%, P = .011), but not glucose ≥10 mmol/L. Increased comorbidity was strongly associated with worse outcome (P < .001) in all models. CONCLUSIONS: SHR provided the best prognostic insight at admission to assess the relationship between SIH and ischemic stroke outcome. Absolute glucose levels failed to account for natural interpatient variation in background glycemia and provided little prognostic insight. To assess the impact of SIH, future interventional studies need to be designed using designated markers of SIH such as SHR in preference to absolute glucose.
BACKGROUND: The aim of this study is to compare metrics specific for stress-induced hyperglycemia (SIH) with glucose for predicting ischemic stroke outcome. METHODS: This observational retrospective study (n = 300) included patients acutely hospitalized for ischemic stroke over a 3.8-year period. We assessed the association between acute ischemic stroke outcome with the stress hyperglycemia ratio (SHR, relative increase in glycemia) and glycemic gap (GG, absolute increase in glycemia) using admission values and 5-day maximum values, along with incidence of poor outcome above recognized clinical thresholds of glucose 10 mmol/L, SHR 1.14, and GG 2.5 mmol/L. RESULTS: At admission, only SHR was associated with outcome after adjustment for clinical covariates (odds ratio [OR] = 2.88; 95% CI: 1.05-7.91; P = .041), while glucose or GG were not. Admission SHR ≥ 1.14 was also an indicator of poor outcome (39.1% vs 23.4%, P = .016), but not glucose ≥10 mmol/L or GG ≥ 2.5 mmol/L. All 5-day maximum glucose metrics were associated with outcome, as was any SHR ≥ 1.14 (40.9% vs 20.1%, P < .001) or GG ≥ 2.5 mmol/L (42.9% vs 23.4%, P = .011), but not glucose ≥10 mmol/L. Increased comorbidity was strongly associated with worse outcome (P < .001) in all models. CONCLUSIONS: SHR provided the best prognostic insight at admission to assess the relationship between SIH and ischemic stroke outcome. Absolute glucose levels failed to account for natural interpatient variation in background glycemia and provided little prognostic insight. To assess the impact of SIH, future interventional studies need to be designed using designated markers of SIH such as SHR in preference to absolute glucose.
Authors: Andrea Da Porto; Carlo Tascini; Gianluca Colussi; Maddalena Peghin; Elena Graziano; Chiara De Carlo; Luca Bulfone; Martina Antonello; Emanuela Sozio; Martina Fabris; Francesco Curcio; Carlo Pucillo; Cristiana Catena; Leonardo A Sechi Journal: Front Med (Lausanne) Date: 2022-08-19