AUTHOR=Duan Honglian , Yun Ho Jun , Rajah Gary Benjamin , Che Fengli , Wang Yanling , Liu Jing , Tong Yanna , Cheng Zhe , Cai Lipeng , Geng Xiaokun , Ding Yuchuan 

TITLE=Large vessel occlusion stroke outcomes in diabetic vs. non-diabetic patients with acute stress hyperglycemia

JOURNAL=Frontiers in Neuroscience

VOLUME=Volume 17 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2023.1073924

DOI=10.3389/fnins.2023.1073924

ISSN=1662-453X

ABSTRACT=Objective: This study assesses whether stress-induced hyperglycemia is a predictor of poor outcome at 3 months for patients with acute ischemic stroke (AIS) treated by endovascular treatment (EVT) and impacted by their previous blood glucose status. Methods: This retrospective study collected data from 576 patients with AIS of large vessel occlusion (LVO) treated by EVT from March 2019 to June 2022. The sample was composed of 230 and 346 patients with and without diabetes mellitus (DM), respectively, based on their premorbid diabetic status. Prognosis was assessed with modified Rankin Scale（mRS）score at 3-month after AIS. Poor prognosis was defined as mRS>2. Stress-induced hyperglycemia was assessed by fasting glucose-to-glycated hemoglobin ratio (GAR). Each group was stratified into 4 groups by quartiles of GAR (Q1–Q4).  Multivariate logistic regression analysis was used to identify relationship between different GAR quartiles and clinical outcome after EVT. Results: In DM group, a poor prognosis was seen in 122 (53%) patients and GAR level was 1.27±0.44. These variables were higher compared to non-DM group and the differences were statistically significant (p<0.05 respectively). Patients with more severe stress-induced hyperglycemia demonstrated a greater incidence of 3-month poor prognosis (DM: Q1,39.7%; Q2, 45.6%; Q3, 58.6%; Q4, 68.4%; p=0.009.non-DM Q1,31%; Q2, 32.6%; Q3, 42.5%; Q4, 64%; p<0.01). However, the highest quartile of GAR was independently associated with 3-month poor outcome (OR 0.34, 95%CI 0.16-0.70, p=0.004), compared to the lowest quartile in non-DM patients after logistic regression, which was not observed in DM patients. Conclusion: The outcome of patients with acute LVO stroke treated with EVT appears to be influenced by premorbid diabetes status. However, the poor prognosis in patients with DM is not independently correlated with stress-induced hyperglycemia. This could be due to the long-term damage of persistent hyperglycemia and the adaptive alterations of diabetic patients’ response to stress following acute ischemic damage to the brain.