Objectives: To investigate the correlation between stress hyperglycemia ratio (SHR) and outcomes in patients with acute ischemic stroke treated with endovascular treatment. Methods: In a multicenter registration study for RESCUE-RE (a registration study for critical care of acute ischemic stroke after recanalization), eligible patients with large vessel occlusion stroke within 24 hours after onset who received endovascular treatment between July 2018 and May 2019 were enrolled. SHR was calculated as the fasting glucose concentration divided by the estimated average glucose concentration and then categorized into four groups according to the quartiles (group Q1, group Q2, group Q3 and group Q4). The primary outcome was poor neurological outcomeat day 90 fromstroke onset [defined as modified Rankin scale (mRS) of 3-6]. Secondary outcomes included early neurological deterioration (END), death within 3 months after stroke onset, and symptomatic intracranial hemorrhage.Multivariable logistic and Cox regression modelswere used to assess the correlation between quartiles of SHR and prognosis in patients with endovascular treatment. Results: A total of 592 patients were enrolled in the study, with a mean age of (63±12) years, and 68.07% were male.The median National Institute of Health stroke scale(NIHSS) score on admission was15(11, 20), and the median SHR was 1.23 (1.07, 1.47), with SHR<1.07 in group Q1, 1.07≤SHR<1.23 in group Q2, 1.23≤SHR<1.47 in group Q3 and SHR≥1.47 in group Q4, respectively. The rate of complete recanalization was lower in group Q4 than that of group Q1 (70.27% vs 83.67%, P=0.026). After fully adjusted for potential covariates, the risk of poor neurological outcome at day 90 from stroke onset in group Q4 was 2.38 folds that of group Q1(adjusted OR= 2.38, 95%CI: 1.57-3.57,P=0.003). The risk of death within 3 months of patients in group Q4 was 1.80 times that of the patients in group Q1, but the difference was not statistically significant(adjusted HR=1.80, 95%CI: 0.90-3.62, P=0.098). Conclusion: Higher SHR was correlated with poor neurological outcome at 3 months in large artery occlusion related acute ischemic stroke patients receiving endovascular therapy.
目的： 评估急性大动脉闭塞性缺血性卒中患者接受血管内治疗后，应激性高血糖指数（SHR）与临床预后的关联。 方法： 入组患者来源于急危重缺血性卒中血管再通治疗监测与管理的队列研究（RESCUE-RE）数据库。筛选2018年7月至2019年5月、发病24 h内、影像学证实为急性大动脉闭塞性缺血性卒中、且接受血管内治疗的患者。SHR通过入院时血糖水平与预估的平均血糖的比值计算得来。依据SHR四分位数，将患者分为4组（分别是Q1组、Q2组、Q3组、Q4组）进行后续分析。主要结局为发病3个月神经功能不良预后［定义为改良Rankin量表（mRS）3~6分］。次要结局包括早期神经功能恶化（END）、发病后3个月内死亡、症状性颅内出血。采用多因素logistic回归模型和多因素Cox比例风险模型评估SHR与患者临床预后指标的关联。 结果： 本研究最终入组592例符合纳排标准的患者。入组患者年龄（63±12）岁，其中男性患者403例（68.07%）。患者基线美国国立卫生研究院卒中量表（NIHSS）评分为15（11，20）分，SHR为1.23（1.07，1.47），即Q1组：SHR<1.07；Q2组：1.07≤SHR<1.23；Q3组：1.23≤SHR<1.47；Q4组：SHR≥1.47。SHR水平较高的患者成功血管再通率更低［Q4组再通率（70.27%）低于Q1组（83.67%）］，且4组间成功血管再通率比较差异有统计学意义（P=0.026）。完全校正潜在协变量后，Q4组患者3个月神经功能不良预后风险是Q1组患者的2.38倍（调整后OR=2.38；95%CI：1.59~3.57，P=0.003）。Q4组患者3个月内的死亡风险是Q1组患者的1.80倍，但差异无统计学意义（调整后HR=1.80，95%CI：0.90~3.62，P=0.098）。 结论： 对急性大动脉闭塞性缺血性卒中后接受血管内治疗的患者，较高的SHR与发病3个月神经功能不良预后相关。.