Stress hyperglycemia is associated with in-hospital mortality in patients with diabetes and acute ischemic stroke

Donghua Mi; Zixiao Li; Hongqiu Gu; Yingyu Jiang; Xingquan Zhao; Yilong Wang; Yongjun Wang

doi:10.1111/cns.13764

Stress hyperglycemia is associated with in-hospital mortality in patients with diabetes and acute ischemic stroke

CNS Neurosci Ther. 2022 Mar;28(3):372-381. doi: 10.1111/cns.13764. Epub 2022 Jan 27.

Authors

Donghua Mi¹, Zixiao Li^{1

2}, Hongqiu Gu^{1

2

3}, Yingyu Jiang^{2

3}, Xingquan Zhao^{1

2}, Yilong Wang^{1

2

3}, Yongjun Wang^{1

2

3

4

5}

Affiliations

¹ Department of Vascular Neurology, Beijing Tiantan Hospital, Capital, Medical University, Beijing, China.
² China National Clinical Research Center for Neurological Diseases, Beijing, China.
³ Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁴ Center for Stroke, Beijing Institute for Brain Disorders, Beijing, China.
⁵ Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.

Abstract

Background and objective: Stress 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 methods: All 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.

Results: A 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).

Conclusions: The 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.

Keywords: diabetes; hyperglycemia; ischemia; mortality; physiological; stress; stroke.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Blood Glucose
Diabetes Mellitus*
Female
Glycated Hemoglobin / analysis
Hospital Mortality
Humans
Hyperglycemia* / complications
Ischemic Stroke*
Male
Retrospective Studies
Risk Factors
Stroke* / etiology

Substances

Blood Glucose
Glycated Hemoglobin A