Duan ZW, Li ZN, Zhai YJ, Liu TF, Zhang CC, Hu T, Wei XE, Rong LQ, Liu HY. Effects of glycemic indicators on early neurological outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis. World J Diabetes 2025; 16(3): 94491 [DOI: 10.4239/wjd.v16.i3.94491]
Corresponding Author of This Article
Hai-Yan Liu, Doctor, PhD, Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, No. 32 Meijian Road, Xuzhou 221006, Jiangsu Province, China. sjnklhy0722@163.com
Research Domain of This Article
Clinical Neurology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Zuo-Wei Duan, Zhi-Ning Li, Yu-Jia Zhai, Teng-Fei Liu, Cui-Cui Zhang, Xiu-E Wei, Liang-Qun Rong, Hai-Yan Liu, Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, Jiangsu Province, China
Ting Hu, Department of Neurology, Medical School of Nanjing University, Xuzhou 221006, Jiangsu Province, China
Co-corresponding authors: Zhi-Ning Li and Hai-Yan Liu.
Author contributions: Duan ZW and Li ZN conceived and designed the study; Hu T collected the data; Duan ZW, Liu TF, and Zhang CC analyzed the data, and drafted and revised the manuscript; Zhai YJ and Wei XE participated in drafting the manuscript; Rong LQ and Liu HY reviewed the manuscript and provided critical revision and final editing; All authors contributed to the article and approved the submitted version.
Supported by the Foundation of Jiangsu Provincial Commission of Health and Family Planning, No. QNRC2016353; and the Commission of Health and Family Planning Xuzhou, No. KC22206.
Institutional review board statement: The study was approved by the Ethic Committee of the Second Affiliated Hospital of Xuzhou Medical University, No. 2020122501.
Informed consent statement: All the authors listed have approved the submitted manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The data underlying this article will be shared on reasonable request to the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hai-Yan Liu, Doctor, PhD, Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, No. 32 Meijian Road, Xuzhou 221006, Jiangsu Province, China. sjnklhy0722@163.com
Received: March 27, 2024 Revised: October 1, 2024 Accepted: December 9, 2024 Published online: March 15, 2025 Processing time: 300 Days and 1.3 Hours
Abstract
BACKGROUND
Stress hyperglycemia (SH) is a common phenomenon that is present in about 50% of patients with acute ischemic stroke (AIS). It is thought to be a main risk factor for poor functional outcome among patients with AIS undergoing intravenous thrombolysis (IVT).
AIM
To investigate the predictive value of glycemic indicators for early neurological outcomes (ENOs) in patients with AIS treated with IVT.
METHODS
We retrospectively reviewed a prospectively collected database of patients with AIS who underwent IVT at the Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, between January 2017 and June 2022. ENO included early neurological improvement (ENI) and early neurological deterioration (END), defined as a decrease or increase in the National Institutes of Health Stroke Scale (NIHSS) score between baseline and 24 hours after IVT. We analyzed the associations between glycemic indicators [including admission hyperglycemia (AH), fasting blood glucose (FBG), and SH ratio (SHR)] and ENO in all patients and in subgroups stratified by diabetes mellitus (DM).
RESULTS
A total of 819 patients with AIS treated with IVT were included. Among these, AH was observed in 329 patients (40.2%). Compared with patients without AH, those with AH were more likely to have a higher prevalence of DM (P < 0.001) and hypertension (P = 0.031) and presented with higher admission NIHSS scores (P < 0.001). During the first 24 hours after IVT, END occurred in 208 patients (25.4%) and ENI occurred in 156 patients (19.0%). Multivariate mixed logistic regression analyses indicated that END was independently associated with AH [odds ratio (OR): 1.744, 95% confidence interval (CI): 1.236-2.463; P = 0.002]. Subjects were classified into four groups representing quartiles. Compared with Q1, patients in the higher quartiles of SHR (Q2: OR: 2.306, 95%CI: 1.342-3.960; P = 0.002) (Q3: OR: 2.284, 95%CI: 1.346-3.876; P = 0.002) (Q4: OR: 3.486, 95%CI: 2.088-5.820; P = 0.001) and FBG (Q3: OR: 1.746, 95%CI: 1.045-2.917; P = 0.033) (Q4: OR: 2.436, 95%CI: 1.476-4.022; P = 0.001) had a significantly higher risk of END in the overall population. However, none of the glycemic indicators were found to be associated with ENI in patients with or without DM.
CONCLUSION
Our study demonstrated that glycemic indicators in patients with stroke treated with IVT were associated with the presence of END rather than ENI during the first 24 hours after admission.
Core Tip: The benefit of intravenous thrombolysis (IVT) is due to arterial recanalization and brain tissue reperfusion, which improve neurological outcomes of patients with acute ischemic stroke (AIS) treated with IVT. There is no consensus on the influence of stress hyperglycemia (SH) on the effects of early neurological outcomes in patients with AIS treated with IVT. This study identified predictors of early neurological improvement (ENI) and early neurological deterioration (END) and demonstrated that admission hyperglycemia, fasting blood glucose, and SH ratio in patients with stroke treated with IVT are associated with END rather than ENI during the first 24 hours after admission.
