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Dynamic Hyperglycemic Patterns Predict Adverse Outcomes in Patients with Acute Ischemic Stroke Undergoing Mechanical
Giovanni Merlino1,2, Carmelo Smeralda2,3, Massimo Sponza4
1Stroke Unit, Department of Neuroscience, Udine University Hospital, 33100 Udine, Italy.
Journal of Clinical Medicine
|June 25, 2020
Summary
Persistent hyperglycemia after mechanical thrombectomy in acute ischemic stroke patients significantly increases risks of poor outcomes, mortality, and complications. Continuous 24-hour glucose monitoring is recommended for better patient management.
Area of Science:
- Neurology
- Endovascular Treatment
- Metabolic Disorders
Background:
- Hyperglycemia is a known factor that worsens outcomes for acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT).
- Hyperglycemia in AIS is dynamic, necessitating an investigation into how glucose level patterns impact patient outcomes.
Purpose of the Study:
- To determine if dynamic patterns of hyperglycemia affect outcomes in acute ischemic stroke patients treated with mechanical thrombectomy.
- To analyze the association between different blood glucose level patterns and patient outcomes post-MT.
Main Methods:
- Retrospective analysis of 200 consecutive AIS patients with prospective follow-up.
- Patients were categorized into four groups based on blood glucose levels: persistent normoglycemia, hyperglycemia at baseline only, hyperglycemia at 24-h only, and persistent hyperglycemia (baseline and 24-h).
Main Results:
- Persistent hyperglycemia was significantly associated with increased risks of poor functional outcome, mortality (in-hospital and 3-month), and hemorrhagic transformation (including symptomatic intracranial hemorrhage).
- These associations remained significant even after excluding diabetic patients.
- The model demonstrated strong predictive performance for poor outcome and mortality (AUC-ROC 0.76-0.79).
Conclusions:
- Persistent hyperglycemia following mechanical thrombectomy is a critical predictor of adverse outcomes in acute ischemic stroke patients.
- Prolonged monitoring of glucose levels for 24 hours after mechanical thrombectomy is clinically valuable for risk assessment and patient management.
