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High glycemic variability: An underestimated determinant of stroke functional outcome following large vessel
Insights
High glycemic variability (GV) in acute ischemic stroke (AIS) patients treated for large vessel occlusion predicts poorer functional outcomes. Early GV monitoring is crucial for stroke management and targeted interventions.
Area of Science:
- Neurology
- Endocrinology
- Cardiovascular Medicine
Background:
- Glycemic variability (GV) is a known negative prognostic factor in diabetic patients post-cardiovascular events.
- The impact of early GV on acute ischemic stroke (AIS) outcomes, particularly in large vessel occlusion (LVO) cases, remains under-investigated.
Purpose of the Study:
- To investigate the association between high early GV and three-month functional outcomes in AIS patients with LVO.
- To evaluate GV as a predictor of functional recovery in patients receiving combined thrombolysis and endovascular therapy.
Main Methods:
- Retrospective analysis of 93 AIS patients with intracranial LVO treated between January 2015 and May 2017.
- Early GV assessed by standard deviation of blood glucose in the first 24 hours.
- Functional outcome measured by modified Rankin Scale (mRS) at three months; secondary outcomes included NIHSS change and hemorrhagic transformation.
Main Results:
- 26 patients (28%) exhibited high early GV (≥20.9 mg/dL).
- High GV was significantly associated with poor functional outcome at three months (OR=8.00; P=0.02).
- Admission and mean glycemia did not predict functional outcome; high GV was not linked to NIHSS changes or hemorrhagic transformation.
Conclusions:
- Acute high glycemic variability is an independent predictor of poorer functional outcomes in AIS patients with LVO.
- Monitoring and managing early GV may represent a novel therapeutic target to improve stroke recovery.
Background And Purpose:
Early glycemic variability (GV) in diabetic patients is a poor prognosis factor following cardiovascular events. However, its influence on the course of acute ischemic stroke (AIS) with large vessel occlusion remains unclear. We investigated the relationship between high GV during acute stroke and three-month functional outcome among patients treated with combined intravenous thrombolysis and endovascular therapy for large vessel occlusion.
Methods:
A single-center retrospective analysis of AIS patients with proximal intracranial occlusion who underwent thrombolysis and mechanical thrombectomy between January 2015 and May 2017. Early GV was assessed using standard deviation (SD) of blood glucose levels for the first 24hours. The main outcome was functional status at three months as defined by the modified Rankin scale (mRS). Secondary outcomes were change in NIHSS score from baseline to 24hours and occurrence of severe hemorrhagic transformation. Multivariate logistic regression analyses including GV, admission glycemia and mean glycemia were performed.
Results:
Among the 93 patients evaluated, 26 had early high GV (≥20.9mg/dl). High GV was associated with poor functional outcome (OR=8.00; 95%CI [1.34-47.89]; P=0.02) unlike admission glycemia and mean glycemia (OR=2.92; 95%CI [0.51-16.60]; P=0.23 and OR=0.36; 95%CI [0.05-2.6]; p=0.31, respectively). High GV was not associated with NIHSS at 24hours or hemorrhagic transformation.
Conclusion:
Acute high GV contributes to poorer functional outcome following AIS related to large vessel occlusion and should be considered as a new target in acute stroke management.
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