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. 2023 Jun;38(6):817-824.
doi: 10.1007/s00380-023-02235-y. Epub 2023 Jan 25.

Risk of recurrent stroke and mortality after cryptogenic stroke in diabetic patients

Alberto Vera #  1 , Alberto Cecconi #  2 , Álvaro Ximénez-Carrillo  3 , Carmen Ramos  3 , Pablo Martínez-Vives  1 , Beatriz Lopez-Melgar  1 , Ancor Sanz-García  4 , Guillermo Ortega  4 , Clara Aguirre  3 , Álvaro Montes  1 , José Vivancos  3 , Luis Jesús Jiménez-Borreguero  5 , Fernando Alfonso  1 ; DECRYPTORING study investigators
Affiliations

Risk of recurrent stroke and mortality after cryptogenic stroke in diabetic patients

Alberto Vera et al. Heart Vessels. 2023 Jun.

Abstract

Background: Diabetes mellitus is a highly prevalent and growing chronic disease that is associated with increased risk of recurrence among several stroke subtypes. However, evidence on the prognostic role of diabetes in the setting of cryptogenic stroke (CS) remains scarce.

Methods: From April 2019 to November 2021, we recruited prospectively 78 consecutive patients with CS. Patients were classified according to the presence of diabetes. Main outcome was the composite of stroke recurrence and death. Secondary outcome was stroke recurrence.

Results: Mean age of the cohort was 78 ± 7.7 years and 18 patients (23%) had diabetes. After a median clinical follow-up of 23 months the incidence of stroke recurrence and mortality [HR 5.8 (95% CI 1.9-19), p = 0.002] and the incidence of stroke recurrence [HR 16.6 (95% CI 1.8-149), p = 0.012], were higher in patients with diabetes. After adjusting for potential confounders diabetes was identified as an independent predictor of stroke recurrence and death in patients with CS [HR 33.8 (95% CI 2.1-551), p = 0.013]. Other independent predictors of stroke recurrence and mortality were hypertension [HR 31.4 (95% CI 1.8-550), p = 0.018], NTproBNP [HR 1.002 (95% CI 1.001-1.004), p = 0.013] and chronic kidney disease (CKD) [HR 27.4 (95% CI 1.4-549) p = 0.03]. Furthermore, diabetes was an independent predictor of stroke recurrence [HR 103 (95% CI 1.3-8261), p = 0.038].

Conclusion: Diabetic patients with CS are at higher risk of stroke recurrence and death. Hypertension CKD and NTproBNP are also independent predictors of stroke recurrence and death after CS.

Keywords: Chronic kidney disease; Cryptogenic stroke; Diabetes; NTproBNP; Stroke recurrence.

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