The stress hyperglycemia ratio is associated with the development of cerebral edema and poor functional outcome in patients with acute cerebral infarction.
The stress hyperglycemia ratio is associated with the development of cerebral edema and poor functional outcome in patients with acute cerebral infarction.
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DOI：
10.3389/fnagi.2022.936862
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发表时间：
2022
影响因子：
4.8
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中科院分区：
文献类型：
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入院时的绝对高血糖已被证明与急性脑梗死后脑水肿（CED）的发展有关。应激性高血糖比绝对高血糖更客观地反映了高血糖状态。然而，关于应激性高血糖与CED之间关系的研究有限。我们的目的是探讨应激性高血糖（以应激性高血糖比（SHR）衡量）与急性脑梗死的CED发展和不良功能结局之间的关系。纳入2017年1月至2021年3月在症状出现后24 h内入住四川大学华西医院神经内科的急性中动脉性脑梗死患者。通过SHR：入院时空腹血糖(FPG)/血红蛋白A1c （HbA1c）评估应激性高血糖。主要观察指标为脑影像评价CED程度。次要结局为中度至重度CED、功能不良结局（改良Rankin量表评分bb0.2）和90天死亡。通过多变量logistic回归分析评估SHR与预后之间的关系。我们进一步比较了SHR、入院随机血糖（RPG）和入院FPG对训练数据集和验证数据集结果的预测价值。638名患者入组。SHR每增加0.1个点与更高程度CED的风险增加1.31倍独立相关[优势比（OR）： 1.31(95%可信区间（CI）： 1.20-1.42), P < 0.001]。SHR与中重度CED[每增加0.1个点：OR: 1.39 (95% CI: 1.24-1.57), P < 0.001]、功能不良结局[每增加0.1个点：OR: 1.25 (95% CI: 1.12-1.40), P < 0.001]和死亡[每增加0.1个点：OR: 1.13 (95% CI: 1.03-1.25), P < 0.05]独立相关。在受试者工作特征分析中，曲线下面积显示的SHR（作为一个连续变量）对中重度CED和功能不良预后的预测价值高于RPG和FPG （P < 0.05）。SHR与CED的严重程度、功能不良结局和急性脑梗死后死亡独立相关，SHR（作为一个连续变量）比RPG和FPG对中重度CED和功能不良结局有更好的预测价值。
Absolute hyperglycemia at admission has been shown to be associated with the development of cerebral edema (CED) after acute cerebral infarction. Stress hyperglycemia is a more objective reflection of hyperglycemic state than absolute hyperglycemia. However, studies on the associations between stress hyperglycemia and CED are limited. We aimed to explore the associations of stress hyperglycemia, measured by stress hyperglycemia ratio (SHR), with the development of CED and poor functional outcome of acute cerebral infarction. Patients with acute middle artery cerebral infarction admitted to the Department of Neurology, West China Hospital of Sichuan University, within 24 h of symptom onset from January 2017 to March 2021 were included. Stress hyperglycemia was assessed by the SHR: admission fasting plasma glucose (FPG)/hemoglobin A1c (HbA1c). The primary outcome was the degree of CED evaluated on brain image. The secondary outcomes were moderate-to-severe CED, poor functional outcome (modified Rankin Scale score > 2), and death at 90 days. The associations between the SHR and outcomes were assessed with multivariate logistic regression analyses. We further compared the predictive value of the SHR, admission random plasma glucose (RPG), and admission FPG for outcomes in the training dataset and validation dataset. 638 patients were enrolled. Each 0.1-point increase in the SHR was independently associated with a 1.31-fold increased risk of a higher degree of CED [odds ratio (OR): 1.31 (95% confidence interval (CI): 1.20–1.42), P < 0.001]. The SHR was independently associated with moderate-to-severe CED [per 0.1-point increase: OR: 1.39 (95% CI: 1.24–1.57), P < 0.001], poor functional outcome [per 0.1-point increase: OR: 1.25 (95% CI: 1.12–1.40), P < 0.001], and death [per 0.1-point increase: OR: 1.13 (95% CI: 1.03–1.25), P < 0.05]. The predictive value of the SHR (as a continuous variable), exhibited by the area under the curve in receiver operating characteristic analysis, was higher than that of the RPG and FPG for moderate-to-severe CED and poor functional outcome (P < 0.05). The SHR is independently associated with the severity of CED, poor functional outcome, and death after acute cerebral infarction, and the SHR (as a continuous variable) has a better predictive value for moderate-to-severe CED and poor functional outcome than the RPG and FPG.
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影响因子：
3.4
作者：
Spronk E;Sykes G;Falcione S;Munsterman D;Joy T;Kamtchum-Tatuene J;Jickling GC
通讯作者：
Jickling GC
影响因子：
3.4
作者：
Merlino G;Pez S;Gigli GL;Sponza M;Lorenzut S;Surcinelli A;Smeralda C;Valente M
通讯作者：
Valente M
影响因子：
8.3
作者：
Ong CJ;Gluckstein J;Laurido-Soto O;Yan Y;Dhar R;Lee JM
通讯作者：
Lee JM
影响因子：
2.9
作者：
Huang, Jingyang;Liu, Baoyi;Yuan, Zhongrui
通讯作者：
Yuan, Zhongrui
应激性高血糖对患有或不患有糖尿病的急性缺血性中风患者的神经功能缺损和死亡率的影响。
影响因子：
3.4
作者：
Li J;Quan K;Wang Y;Zhao X;Li Z;Pan Y;Li H;Liu L;Wang Y
通讯作者：
Wang Y