SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Stroke
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1692103
This article is part of the Research TopicDissecting Vascular Dysfunction in Stroke: Using Translational Research Models to Advance Biomarkers Discovery and Preventative MedicineView all articles
Fasting blood glucose-to-glycated hemoglobin ratio and functional outcome of patients with ischemic stroke after endovascular treatment: a meta-analysis
Provisionally accepted
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Background: Stress hyperglycemia is common in acute ischemic stroke (IS) and has been linked to adverse outcomes. The fasting glucose-to-HbA1c ratio (GAR) has been proposed as a simple marker reflecting stress hyperglycemia relative to chronic glycemic status, but its prognostic value in patients undergoing endovascular treatment (EVT) remains unclear. This meta-analysis aimed to evaluate the association between GAR and 90-day functional outcomes in these patients. Methods: PubMed, Embase, Web of Science, Wanfang and CNKI were systematically searched through May 29, 2025. Studies reporting the association between GAR and poor functional outcome, defined as a modified Rankin Scale (mRS) score of 3–6 at 90 days, were included. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model accounting for heterogeneity. Results: Twelve datasets from ten retrospective cohort studies involving 3,878 patients were analyzed. The pooled analysis showed that a high GAR was significantly associated with an increased risk of poor functional outcome at 90 days after EVT (OR: 2.94, 95% CI: 2.22–3.88, p < 0.001; I² = 14%). Meta-regression indicated that the proportion of diabetic patients showed a trend toward explaining the observed heterogeneity (coefficient = –0.0088, p = 0.08; I² residual = 0%), whereas other factors showed no significant influence. Subgroup analyses yielded consistent results across age, sex, diabetes status, NIHSS, GAR cutoffs, and study quality (p for subgroup difference all > 0.05). The certainty of evidence for the primary outcome was rated as moderate according to the GRADE framework, mainly due to the retrospective design. Conclusion: High GAR may independently predict poor 90-day functional outcomes after EVT in patients with IS, supporting its potential prognostic value in clinical practice.
Keywords: Glucose-to-glycated hemoglobin ratio, ischemic stroke, functional outcome, stress hyperglycemia, Meta-analysis
Received: 25 Aug 2025; Accepted: 11 Oct 2025.
Copyright: © 2025 Hong, Wang, Chen and Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ying Sun, sunying2022_hey@hotmail.com
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