Postoperative Blood Glucose Trajectories are Associated with Inflammatory Markers and Functional Outcomes in Acute Ischemic Stroke Treated by Thrombectomy.

Abstract

Purpose: To describe postoperative blood glucose trajectories in patients with acute ischemic stroke treated by mechanical thrombectomy (MT) and to examine their associations with 90-day functional outcomes and early postoperative inflammatory markers.

Patients and methods: This retrospective cohort study included 150 patients who underwent MT for large vessel occlusion (LVO) stroke between March 2023 and September 2024. Daily capillary blood glucose levels (fasting and postprandial) were recorded for seven days post-procedure, and linear regression was used to calculate individual postoperative glucose slopes. Patients were classified into a Glucose-Increasing Group or Glucose-Decreasing Group based on the median slope. The primary outcome was the 90-day modified Rankin Scale (mRS). Secondary outcomes included postoperative day-1 levels of C-reactive protein (CRP), interleukin-6 (IL-6), and interleukin-10 (IL-10). Statistical analyses included group comparisons and multivariate logistic regression adjusting for potential confounders.

Results: Patients in the Glucose-Increasing Group had significantly higher median 90-day mRS scores compared with the Glucose-Decreasing Group (4.0 vs 3.0; P = 0.030). They also exhibited higher postoperative inflammatory markers: CRP (5.2 vs 4.1 mg/L; P = 0.022), IL-6 (6.9 vs 5.7 pg/mL; P = 0.015), and IL-10 (134 vs 104 pg/mL; P = 0.0017). However, in multivariate logistic regression, glucose trajectory was not an independent predictor of poor outcome (mRS ≥ 3; OR 0.67, 95% CI 0.34-1.37; P = 0.272).

Conclusion: An increasing postoperative blood glucose trend is associated with higher early inflammatory marker levels and poorer 90-day functional outcomes in LVO stroke patients undergoing thrombectomy. Although not an independent predictor after adjustment, postoperative glycemic trajectory may reflect underlying metabolic and inflammatory stress. Prospective studies are needed to further clarify these relationships.