The stress-induced hyperglycemia ratio in the prognosis prediction of patients with acute ischemic stroke one year after thrombolytic therapy

doi:10.16150/j.1671-2870.2021.06.009

Abstract

Abstract:

Objective: To explore the association of stress-induced hyperglycemia ratio (SHR) and the prognosis of patients with acute ischemic stroke one year after thrombolytic therapy. Methods: A total of 262 patients with acute ischemic stroke, including 84 diabetics and 178 non-diabetics, who received thrombolytic therapy from January 2018 to January 2020 were enrolled in the study. The average levels of SHR calculated within 24 hours of admission were 0.859 and 0.914 in non-diabetics and diabetics, and patients were divided into low and high SHR group, with SHR below or above average level. The general clinical parameters and the mortality rate within 1 year after discharge were compared among diabetic and non-diabetics in low and the high SHR group. Cox univariate and multivariate regression were adopted in independent risk factor analysis for prognosis, and the Receiver operating curve (ROC) was plotted to evaluate the SHR in prognosis prediction. Results: Both diabetic and nondiabetic patients in high SHR group had higher NIHSS score, incidence of stress hyperglycemia, fasting blood glucose and glycosylated hemoglobin levels than patients in low SHR groups (P<0.05). The 1-year mortality rate of the non-diabetic and diabetic high SHR groups were 32.9%(28/85) and 48.9% (22/45), which were higher than their counterparts in low SHR groups, with 17.2%(16/93) and 17.9% (7/39) respectively ( χ²=5.910, P=0.015; and χ²=10.008, P=0.002). For patients with high SHR, the diabetics had higher 1-year mortality rate than the non-diabetics( χ²=4.075, P=0.044). NIHSS score, stress hyperglycemia, glycosylated hemoglobin, and SHR levels were all independent risk factors for the prognosis of patients 1 year after discharge. The ROC curve of SHR for adverse outcomes within one year after discharge revealed the AUC of 0.897 (95%CI=0.814-0.913) and 0.841(95%CI=0.804-0.861) in diabetics and non-diabetics with acute ischemic stroke respectively. Conclusions: High SHR is associated with decreased 1-year survival rate after thrombolytic therapy for acute ischemic stroke and is an independent risk factor for poor prognosis.

Key words: Acute ischemic stroke, Stress hyperglycemia ratio, Poor prognosis, Risk factors

CLC Number:

R743.3

LIANG Yali, ZHAO Haigang, XIANG Guangyu. The stress-induced hyperglycemia ratio in the prognosis prediction of patients with acute ischemic stroke one year after thrombolytic therapy[J]. Journal of Diagnostics Concepts & Practice, 2021, 20(06): 562-566.

Figures/Tables 4

References 23

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因素	非糖尿病组		t/χ²	P值	糖尿病组		t/χ²值	P值
因素	低SHR组	高SHR组	t/χ²	P值	低SHR组	高SHR组	t/χ²值	P值
性别（男/女）	54/39	52/33	0.179	0.673	25/14	26/19	0.350	0.554
年龄（岁）	65.3±3.6	66.1±4.1	0.872	0.386	66.2±3.1	66.8±4.3	0.512	0.698
体指数（kg/m²）	24.3±3.2	24.8±3.6	0.745	0.415	24.5±3.6	25.1±3.3	0.841	0.412
高血压病史	48（51.6）	47（55.3）	0.242	0.623	25（64.1）	27（60.0）	1.161	0.281
血脂异常	44（47.3）	43（50.6）	0.191	0.662	15（38.5）	18（40.0）	0.021	0.886
冠心病史	12（12.9）	13（15.3）	0.210	0.647	7（17.9）	9（20.0）	0.057	0.811
吸烟史	60（64.5）	56（65.9）	0.037	0.848	20（51.3）	24（53.3）	0.035	0.851
NIHSS评分（分）	10.6±2.5	14.6±3.1	5.025	<0.001	12.3±3.2	16.3±3.6	5.362	<0.001
应激性高血糖	4（4.3）	27（31.8）	23.289	<0.001	10（25.6）	32（71.1）	17.297	<0.001
空腹血糖（mmol/L）	5.1±0.4	6.5±1.1	3.854	0.010	8.3±2.1	10.9±3.2	4.230	0.004
HbA1c（%）	4.6±0.5	5.1±0.3	3.562	0.026	8.1±1.5	9.5±1.7	3.421	0.030
甘油三酯（mmol/L）	1.7±0.6	1.8±0.8	0.652	0.562	2.1±0.5	2.3±0.8	0.472	0.685
总胆固醇（mmol/L）	4.2±0.8	4.4±0.8	1.256	0.108	4.4±0.9	4.5±1.0	0.068	0.914
高密度脂蛋白（mmol/L）	1.0±0.3	1.1±0.3	0.582	0.625	0.9±0.3	1.0±0.2	0.652	0.514
低密度脂蛋白（mmol/L）	2.8±0.7	2.6±0.7	1.325	0.085	2.5±0.8	2.6±0.8	0.952	0.301

结局	非糖尿病组		糖尿病组
结局	低SHR组	高SHR组	低SHR组	高SHR组
死亡	16（17.2）	28（32.9）	7（17.9）	23（51.1）
存活	77（82.8）	57（67.1）	32（82.1）	22（48.9）
χ²（P）	5.910（0.015）		8.848（0.003）

因素	单因素		多因素
因素	OR值（95%CI）	P值	OR值（95%CI）	P值
NIHSS评分	1.526（1.025~3.362）	0.021	1.325（1.007~3.054）	0.035
应激性高血糖发生率	1.625（1.201~5.230）	0.006	1.481（1.052~4.321）	0.010
空腹血糖	1.025（1.008~1.325）	0.016	1.021（0.985~1.265）	0.068
HbA1c	1.652（1.214~4.326）	0.004	1.526（1.158~3.415）	0.016
SHR	1.526（1.107~4.182）	0.014	1.214（1.010~2.869）	0.026