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. 2024 Jan 12;24(1):24.
doi: 10.1186/s12883-024-03527-0.

The impact of stress hyperglycemia ratio on short-term and long-term outcomes for acute basilar artery occlusion underwent endovascular treatment

Zhouzhou Peng #  1 , Yan Tian #  1 , Jinrong Hu #  1 , Jie Yang #  1 , Linyu Li  1 , Jiacheng Huang  1 , Weilin Kong  1 , Changwei Guo  1 , Xiang Liu  1 , Dahong Yang  1 , Chengsong Yue  1 , Nizhen Yu  1 , Fengli Li  1 , Wenjie Zi  1 , Jiaxing Song  2 , Qingwu Yang  3
Affiliations

The impact of stress hyperglycemia ratio on short-term and long-term outcomes for acute basilar artery occlusion underwent endovascular treatment

Zhouzhou Peng et al. BMC Neurol. .

Abstract

Background: Stress hyperglycemia ratio (SHR) reflects a true acute hyperglycemic state during acute basilar artery occlusion (ABAO). We aimed to investigate the association between SHR and short-term and long-term outcomes in patients with ABAO receiving endovascular treatment (EVT).

Methods: We selected patients treated with EVT from the BASILAR study, a nationwide prospective registry. A total 250 patients with documented glucose and glycated hemoglobin (HbA1C) values at admission were included. SHR was calculated as the ratio of glucose/HbA1C. All 250 patients completed 90 days of follow-up and 234 patients (93.6%) completed 1 year of follow-up. The primary outcome was the favorable outcome defined as modified Rankin Scale (mRS) score ≤ 3 at 90 days. Safety outcomes included mortality at 90 days and 1 year, and intracranial hemorrhage.

Results: Among the 250 patients included, patients with higher tertiles of SHR were associated with decreased odds of a favorable functional outcome at 90 days (adjusted OR, 0.26; 95% CI, 0.12-0.56; P = 0.001 and adjusted OR, 0.37; 95% CI, 0.18-0.80; P = 0.01; respectively) and 1 year (adjusted OR, 0.34; 95% CI, 0.16-0.73; P = 0.006 and adjusted OR, 0.38; 95% CI, 0.18-0.82; P = 0.01; respectively) after adjusting for confounding covariates. The mortality was comparable across tertiles of SHR groups at 90 days and 1 year.

Conclusions: Our study showed that SHR was associated with a decreased probability of favorable functional outcome both at 90 days and 1 year after EVT in patients with ABAO. The relationship was more pronounced in non-diabetes patients.

Trial registration: Clinical Trial Registry Identifier: ChiCTR1800014759 (November 12, 2013).

Keywords: Acute basilar artery occlusion; Endovascular treatment; Stress hyperglycemia ratio; Stroke.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Modified Rankin Scale scores at 90 days and 1 year. The distributions of the modified Rankin Scale (mRS) score for favorable clinical outcome and mortality at 90 days (A) and 1 year (B) among patients after EVT were presented according to the trichotomized SHR. SHR indicates stress hyperglycemia ratio
Fig. 2
Fig. 2
Subgroup analyses of clinical outcomes. The forest plot shows the differences in odds ratios (ORs) for favorable outcome at 90 days (A) and 1 year (B) in subgroups. Adjusted variables include age, sex, severity of stroke, hypertension, smoking, diabetes mellitus, intravenous thrombolysis, stroke etiology and occlusion site. LAA, large artery atherosclerosis; BA, basilar artery; VA-V4, vertebral artery V4 segment, IVT, intravenous thrombolysis
Fig. 3
Fig. 3
Survival probability within 1 year. Kaplan–Meier curves show the time to survival probability according to the trichotomized stress hyperglycemia ratio (SHR)
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