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. 2024 Jun 18;23(1):206.
doi: 10.1186/s12933-024-02260-9.

Acute-to-chronic glycemic ratio as an outcome predictor in ischemic stroke in patients with and without diabetes mellitus

Elisenda Climent #  1   2   3 , Ana Rodriguez-Campello #  2   3   4   5 , Joan Jiménez-Balado  2   4   5 , Mercè Fernández-Miró  1   2   3 , Jordi Jiménez-Conde  2   3   4   5 , Gemma Llauradó  1   2   3   6 , Ángel Ois  2   3   4   5 , Juana A Flores  1   2   3 , Elisa Cuadrado-Godia  2   3   4   5 , Eva Giralt Steinhauer  2   3   4   5 , Juan J Chillarón  7   8   9 ; Neurovascular Research Group (NEUVAS)
Collaborators, Affiliations

Acute-to-chronic glycemic ratio as an outcome predictor in ischemic stroke in patients with and without diabetes mellitus

Elisenda Climent et al. Cardiovasc Diabetol. .

Abstract

Objective: Elevated plasma glucose levels are common in patients suffering acute ischemic stroke (AIS), and acute hyperglycemia has been defined as an independent determinant of adverse outcomes. The impact of acute-to-chronic glycemic ratio (ACR) has been analyzed in other diseases, but its impact on AIS prognosis remains unclear. The main aim of this study was to assess whether the ACR was associated with a 3-month poor prognosis in patients with AIS.

Research, design and methods: Retrospective analysis of patients admitted for AIS in Hospital del Mar, Barcelona. To estimate the chronic glucose levels (CGL) we used the formula eCGL= [28.7xHbA1c (%)]-46.7. The ACR (glycemic at admission / eCGL) was calculated for all subjects. Tertile 1 was defined as: 0.28-0.92, tertile 2: 0.92-1.13 and tertile 3: > 1.13. Poor prognosis at 3 months after stroke was defined as mRS score 3-6.

Results: 2.774 subjects with AIS diagnosis were included. Age, presence of diabetes, previous disability (mRS), initial severity (NIHSS) and revascularization therapy were associated with poor prognosis (p values < 0.05). For each 0.1 increase in ACR, there was a 7% increase in the risk of presenting a poor outcome. The 3rd ACR tertile was independently associated with a poor prognosis and mortality. In the ROC curves, adding the ACR variable to the classical clinical model did not increase the prediction of AIS prognosis (0.786 vs. 0.781).

Conclusions: ACR was positively associated with a poor prognosis and mortality at 3-months follow-up after AIS. Subjects included in the 3rd ACR tertile presented a higher risk of poor prognosis and mortality. Baseline glucose or ACR did not add predictive value in comparison to only using classical clinical variables.

Keywords: Acute-to-chronic glycemic ratio; Diabetes; Hyperglycemia; Ischemic stroke; Mortality, outcome.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
ROC curve comparing classical clinical variables vs. adding ACR o baseline glucose in the prediction of poor stroke outcome and mortality. Model: Rankin score > 1, age, gender, diabetes, dyslipidemia, revascularization treatment, history Rankin, baseline NIHSS
See this image and copyright information in PMC

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