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Glucose-6-phosphate dehydrogenase deficiency and stroke outcomes
Zilin Ou1, Yicong Chen2, Jianle Li2
1From Section II (S.X.), Department of Neurology (Z.O., Y.C., J.L., F.O., G.L., S.T., W.H., J.Z.), The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou; Department of Epidemiology and Biostatistics (X.G.), School of Public Health, Guangdong Pharmaceutical University; Department of Neurology and Stroke Center (Y.Z.), The First Affiliated Hospital of Jinan University, Guangzhou; Department of Neurology (Z.L.), The First Affiliated Hospital of Guangxi Medical University, Nanning; and Department of Neurology (W.D.), Meizhou Hospital Affiliated to Sun Yat-sen University, China. zengjs@pub.guangzhou.gd.cn xingshih@mail.sysu.edu.cn.
Objective:
To assess the risk of glucose-6-phosphate dehydrogenase (G6PD) on stroke prognosis, we compared outcomes between patients with stroke with and without G6PD deficiency.
Methods:
The study recruited 1,251 patients with acute ischemic stroke. Patients were individually categorized into G6PD-deficiency and non-G6PD-deficiency groups according to G6PD activity upon admission. The primary endpoint was poor outcome at 3 months defined by a modified Rankin Scale (mRS) score ≥2 (including disability and death). Secondary outcomes included the overall mRS score at 3 months and in-hospital death and all death within 3 months. Logistic regression and Cox models, adjusted for potential confounders, were fitted to estimate the association of G6PD deficiency with the outcomes.
Results:
Among 1,251 patients, 150 (12.0%) were G6PD-deficient. Patients with G6PD deficiency had higher proportions of large-artery atherosclerosis (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.09-2.17) and stroke history (OR 1.93, 95% CI 1.26-2.90) compared to the non-G6PD-deficient group. The 2 groups differed significantly in the overall mRS score distribution (adjusted common OR 1.57, 95% CI 1.14-2.17). Patients with G6PD deficiency had higher rates of poor outcome at 3 months (adjusted OR 1.73, 95% CI 1.08-2.76; adjusted absolute risk increase 13.0%, 95% CI 2.4%-23.6%). The hazard ratio of in-hospital death for patients with G6PD-deficiency was 1.46 (95% CI 1.37-1.84).
Conclusions:
G6PD deficiency is associated with the risk of poor outcome at 3 months after ischemic stroke and may increase the risk of in-hospital death. These findings suggest the rationality of G6PD screening in patients with stroke.
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