{"title":"Association between hyperglycemia and unfavorable outcome in patients with successful thrombectomy for acute ischemic stroke: a single-center study.","authors":"Ao Qian, Longyi Zheng, Shuang Tang, Wenli Xing","doi":"10.1186/s12883-025-04357-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to evaluate the associations between hyperglycemia, dynamics of glucose levels and unfavorable outcome in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT).</p><p><strong>Methods: </strong>A retrospective study was conducted in our center. Blood glucose levels were measured at admission, immediately following MT procedure, and under fasting condition the next morning. Two patterns of blood glucose increase (BGI) were defined: postoperative BGI as higher postoperative blood glucose level than the value at admission, and fasting BGI as fasting blood glucose level exceeding the value at admission. Hyperglycemia was classified as any blood glucose measurements ≥ 8 mmol/L. Unfavorable outcome was defined as a modified Rankin Scale (mRS) score > 2 at 90 days after onset. Multivariable logistic regression was performed to assess the associations of blood glucose levels at three time points (admission, postoperative, and the next-morning fasting), BGI, and unfavorable outcome. Lastly, mediation analysis was conducted to assess the potential mediating role of systemic inflammatory response in the association between hyperglycemia and unfavorable outcome.</p><p><strong>Results: </strong>A total of 395 patients were enrolled, and 224 (56.7%) experienced unfavorable outcome. After multivariable adjustment, admission (adjusted odds ratio [aOR] 4.030, 95% CI 2.200-7.382), postoperative (aOR 2.462, 95% CI 1.354-4.476), and fasting hyperglycemia (aOR 4.309, 95% CI 2.271-8.176) were independently associated with unfavorable outcome. Moreover, fasting BGI was also found as a significant risk factor for unfavorable outcome (aOR 2.077, 95% CI 1.167-3.696). The relationships of admission and fasting hyperglycemia with unfavorable outcome were mediated by systemic inflammation markers, with mediation proportions ranging from 10.4 to 21.8% (all p < 0.05).</p><p><strong>Conclusion: </strong>Our findings support hyperglycemia and fasting BGI indicating elevated risk of unfavorable outcome in AIS patients undergoing MT, with systemic inflammation partially mediating these association.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"25 1","pages":"333"},"PeriodicalIF":2.2000,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12344935/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Neurology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12883-025-04357-4","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: The aim of this study was to evaluate the associations between hyperglycemia, dynamics of glucose levels and unfavorable outcome in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT).
Methods: A retrospective study was conducted in our center. Blood glucose levels were measured at admission, immediately following MT procedure, and under fasting condition the next morning. Two patterns of blood glucose increase (BGI) were defined: postoperative BGI as higher postoperative blood glucose level than the value at admission, and fasting BGI as fasting blood glucose level exceeding the value at admission. Hyperglycemia was classified as any blood glucose measurements ≥ 8 mmol/L. Unfavorable outcome was defined as a modified Rankin Scale (mRS) score > 2 at 90 days after onset. Multivariable logistic regression was performed to assess the associations of blood glucose levels at three time points (admission, postoperative, and the next-morning fasting), BGI, and unfavorable outcome. Lastly, mediation analysis was conducted to assess the potential mediating role of systemic inflammatory response in the association between hyperglycemia and unfavorable outcome.
Results: A total of 395 patients were enrolled, and 224 (56.7%) experienced unfavorable outcome. After multivariable adjustment, admission (adjusted odds ratio [aOR] 4.030, 95% CI 2.200-7.382), postoperative (aOR 2.462, 95% CI 1.354-4.476), and fasting hyperglycemia (aOR 4.309, 95% CI 2.271-8.176) were independently associated with unfavorable outcome. Moreover, fasting BGI was also found as a significant risk factor for unfavorable outcome (aOR 2.077, 95% CI 1.167-3.696). The relationships of admission and fasting hyperglycemia with unfavorable outcome were mediated by systemic inflammation markers, with mediation proportions ranging from 10.4 to 21.8% (all p < 0.05).
Conclusion: Our findings support hyperglycemia and fasting BGI indicating elevated risk of unfavorable outcome in AIS patients undergoing MT, with systemic inflammation partially mediating these association.
目的:本研究的目的是评估急性缺血性卒中(AIS)患者机械取栓(MT)的高血糖、血糖水平动态和不良结局之间的关系。方法:在本中心进行回顾性研究。在入院时、MT手术后立即和第二天早上空腹条件下测量血糖水平。定义了两种血糖升高(BGI)模式:术后BGI是指术后血糖水平高于入院时,空腹BGI是指空腹血糖水平超过入院时。血糖≥8 mmol/L即为高血糖。不良预后定义为发病后90天的改良Rankin量表(mRS)评分bb0.2。采用多变量logistic回归来评估三个时间点(入院、术后和次日晨禁食)血糖水平、BGI和不良结局的相关性。最后,进行了中介分析,以评估全身性炎症反应在高血糖和不良结局之间的潜在中介作用。结果:共纳入395例患者,其中224例(56.7%)出现不良结局。多变量调整后,入院(调整优势比[aOR] 4.030, 95% CI 2.200-7.382)、术后(aOR 2.462, 95% CI 1.354-4.476)和空腹高血糖(aOR 4.309, 95% CI 2.271-8.176)与不良结局独立相关。此外,空腹BGI也是不良结局的重要危险因素(aOR 2.077, 95% CI 1.167-3.696)。入院和空腹高血糖与不良结局的关系是由全身性炎症标志物介导的,中介比例从10.4%到21.8%不等(均为p)。结论:我们的研究结果支持高血糖和空腹BGI表明接受MT的AIS患者不良结局的风险增加,全身性炎症部分介导了这些关联。
期刊介绍:
BMC Neurology is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of neurological disorders, as well as related molecular genetics, pathophysiology, and epidemiology.