High Stress Hyperglycemia Ratio Predicts Poor Outcome after Mechanical Thrombectomy for Ischemic Stroke

Xingyu Chen; Zhaoji Liu; Jiayin Miao; Weihong Zheng; Qingwei Yang; Xiaowen Ye; Xiaorong Zhuang; Feng Peng

doi:10.1016/j.jstrokecerebrovasdis.2019.02.022

High Stress Hyperglycemia Ratio Predicts Poor Outcome after Mechanical Thrombectomy for Ischemic Stroke

J Stroke Cerebrovasc Dis. 2019 Jun;28(6):1668-1673. doi: 10.1016/j.jstrokecerebrovasdis.2019.02.022. Epub 2019 Mar 16.

Authors

Xingyu Chen¹, Zhaoji Liu¹, Jiayin Miao¹, Weihong Zheng¹, Qingwei Yang¹, Xiaowen Ye¹, Xiaorong Zhuang², Feng Peng³

Affiliations

¹ Department of Neurology, Zhongshan Hospital Xiamen University, Xiamen, China; Department of Neurology, Zhongshan Hospital, The Union Clinical Medical school of Fujian medical university, Xiamen, China.
² Department of Neurology, Zhongshan Hospital Xiamen University, Xiamen, China; Department of Neurology, Zhongshan Hospital, The Union Clinical Medical school of Fujian medical university, Xiamen, China. Electronic address: zxr63@126.com.
³ Department of Neurology, Zhongshan Hospital Xiamen University, Xiamen, China; Department of Neurology, Zhongshan Hospital, The Union Clinical Medical school of Fujian medical university, Xiamen, China. Electronic address: pppfeng@yeah.net.

PMID: 30890395
DOI: 10.1016/j.jstrokecerebrovasdis.2019.02.022

Abstract

Objective: The present study aimed to evaluate the association between stress hyperglycemia ratio (SHR) and outcome at 3 months after mechanical thrombectomy (MT) for acute occlusion in the anterior circulation.

Methods: Data from 160 consecutive patients with large vessel occlusion in the anterior circulation who underwent MT from May 2013 to March 2018 were retrospectively reviewed. SHR was calculated as the fasting glucose concentration divided by the estimated average glucose concentration (derived from the glycosylated hemoglobin level). Patients were dichotomized into 2 groups in accordance with the median SHR. Univariate and multivariate analyses were used to identify predictors of functional outcome. Good and poor outcomes were defined as modified Rankin Scale scores of 0-2 and 3-6, respectively.

Results: patients with unfavorable outcome had significantly higher levels of SHR than those with favorable outcome (median in SHR = 1.02 versus .84, P = .000). The median SHR was .96. Univariate analysis showed that significantly more patients with a poor outcome had SHR ≥ .96 compared with those with a good outcome (65.2% versus 31.0%, P = .000). After adjusting for potential covariates, Increased SHR (odds ratio [OR] 6.97, 95% confidence intervals [CI] 1.22-39.65, P = .029, for continuous SHR levels) and SHR ≥ .96 (OR 3.12, 95% CI 1.39-6.96, P = .006) remained independent predictors of poor outcome.

Conclusions: Increased SHR is strongly correlated with poor outcome at 3 months after MT for proximal artery occlusion in the anterior circulation.

Keywords: Stress hyperglycemia; ischemic stroke; mechanical thrombectomy; outcome.

MeSH terms

Aged
Biomarkers / blood
Blood Glucose / metabolism*
Brain Ischemia / complications
Brain Ischemia / diagnosis
Brain Ischemia / therapy*
Disability Evaluation
Female
Glycated Hemoglobin / metabolism
Humans
Hyperglycemia / blood
Hyperglycemia / complications*
Hyperglycemia / diagnosis
Male
Middle Aged
Recovery of Function
Retrospective Studies
Risk Assessment
Risk Factors
Stress, Physiological*
Stroke / complications
Stroke / diagnosis
Stroke / therapy*
Thrombectomy* / adverse effects
Time Factors
Treatment Outcome

Substances

Biomarkers
Blood Glucose
Glycated Hemoglobin A
hemoglobin A1c protein, human