Relationship of initial glucose level and all-cause death in patients with ischaemic stroke: the roles of diabetes mellitus and glycated hemoglobin level
Relationship of initial glucose level and all-cause death in patients with ischaemic stroke: the roles of diabetes mellitus and glycated hemoglobin level
复制标题
DOI：
10.1111/j.1468-1331.2011.03647.x
复制
发表时间：
2012-06-01
影响因子：
5.1
通讯作者：
Chien, K. -L.
中科院分区：
文献类型：
--
作者：
Hu, G. -C.;Hsieh, S. -F.;Chien, K. -L.
背景与目的：既往研究表明，脑卒中后高血糖与非糖尿病患者的不良预后相关。然而，在糖尿病患者中证据不确定。本研究的目的是评估急性缺血性卒中患者初始血糖水平与死亡率之间的关系，并进一步评估这种关系是否因糖尿病和糖化血红蛋白（HbA 1c）水平而异。研究方法：数据收集自2008年1月1日至2009年6月30日期间急诊室收治的1277例首次卒中患者的病历。进行考克斯回归分析以评估初始血糖水平与死亡率之间的关系。结果如下：与初始血糖水平的最低四分位数相比，在最高四分位数中观察到与全因死亡[风险比（HR），2.18; 95%CI，1.363.48]和心血管死亡（HR，1.91; 95%CI，1.013.61）的显著相关性。在非糖尿病亚组中，初始血糖水平最高四分位数的患者与最低四分位数的患者相比，全因死亡的相对风险（RR）为3.29倍[95%置信区间（CI），1.626.68]，心血管死亡的RR为2.54倍（95% CI，1.438.77）。然而，在糖尿病患者中，初始血糖水平与死亡风险之间的相关性并不显著（相互作用P = 0.01）。此外，糖尿病患者的风险因HbA 1c水平而异。结论：非糖尿病缺血性卒中患者的初始血糖水平与死亡率之间存在显著相关性。初始血糖水平、HbA 1c水平和糖尿病缺血性脑卒中患者死亡率之间的可能关系值得进一步研究。
Background and purpose: Previous studies demonstrated that post-stroke hyperglycemia was associated with poor outcome in non-diabetic patients. However, evidence was inconclusive amongst patients with diabetes. The aim of this study was to evaluate the relationship between initial glucose levels and mortality amongst patients with acute ischaemic stroke, and further, to assess whether the association varied by diabetes mellitus and glycated hemoglobin (HbA1c) levels. Methods: Data were collected from the medical records of 1277 first-ever stroke patients admitted to the emergency room between January 1, 2008 and June 30, 2009. Cox regression analysis was performed to assess the relationship between initial glucose level and mortality. Results: Compared with the lowest quartile of initial glucose level, a significant association with all-cause death [hazard ratio (HR), 2.18; 95% CI, 1.363.48] and cardiovascular death (HR, 1.91; 95% CI, 1.013.61) was seen in the highest quartile. In non-diabetic subgroup, those patients within the highest quartile of initial glucose level had a 3.29-fold relative risks (RR) [95% confidence interval (CI), 1.626.68] for all-cause and a 2.54-fold RR (95% CI, 1.438.77) for cardiovascular death compared with those within the lowest quartile. However, the association between initial glucose levels and the risk of death was not significant amongst those with diabetes (P for interaction = 0.01). In addition, the risk amongst patients with diabetes varied by the HbA1c levels. Conclusions: A significant association was confirmed between initial glucose level and mortality in non-diabetic ischaemic stroke patients. The possible relationship between initial glucose level, HbA1c level, and mortality amongst ischaemic stroke patients with diabetes warrants further research.