A Glycemia-Based Nomogram for Predicting Outcome in Stroke Patients after Endovascular Treatment

Objective: Higher fasting glucose is thought to be associated with adverse outcome in patients receiving endovascular treatment (EVT), while the effect of glycosylated hemoglobin (HbA_1c) on outcome is controversial. We combined fasting blood glucose (FBG) with HbA_1c and evaluated their relationship with the three-month functional outcome in patients who underwent EVT. Methods: Data from 739 consecutive ischemic stroke patients who underwent EVT from April 2015 to August 2021 were retrospectively reviewed. HbA_1c was used to estimate the chronic glucose level according to the following formula: chronic glucose level (mg/dL) = 28.7 × HbA_1c (%) - 6.7. Patients were split into two groups in accordance with the three-month modified Rankin Scale (mRS). Univariate and multivariate analyses were utilized to investigate the association of outcome with blood glucose and to identify other predictors of prognosis. Results: Patients with poor outcome had significantly higher FBG, chronic glycemia, FBG/chronic glycemic ratio, and difference between FBG and chronic glycemia (Δ_A-C). FBG, the FBG/chronic glycemic ratio, and Δ_A-C remained to be associated with poor outcome after adjustment. We then established a glycemia-based nomogram with a concordance index of 0.841, and it showed favorable clinical utility according to decision curve analysis. Conclusions: Glycemia after EVT was connected with the functional outcome and a nomogram based on glycemia may be used to predict prognosis in stroke patients treated with EVT.