Admission hyperglycemia predicts disability despite recanalization after mechanical thrombectomy in acute ischemic...

Type 2 diabetes (T2D) and admission hyperglycemia have been related to poor functional prognosis in patients with ischemic stroke. We aimed to evaluate the role of both in predicting prognosis of patients with ischemic stroke in whom recanalization has been achieved.

  Retrospective study of adult patients with ischemic stroke and anterior or posterior circulation large vessel occlusion who were admitted to the  Stroke Unit of University Hospital Nuestra Señora de Candelaria between February 2015 and December 2021, who underwent endovascular therapy with or without intravenous alteplase (n = 380). According to the modified Rankin scale, the sample was categorized in favorable (0-2) and unfavorable(3-6) outcome at three months.

   Of the 380 patients, 266 patients achieved complete recanalization (79.2%), which constituted the study sample. 33.1% had an unfavorable outcome. The predictive cut-off point for poor functional prognosis of admission glucose was determined, which was ≥113 mg/dl (AUC = 0.73; 95%CI = 0.67-0.79; p < 0.001), with sensitivity 74.4% and specificity 71.5%. This threshold showed a statistically significant difference in AUC when compared to the standard cutoff of point 140 mg/dl (p = 0.001). In multivariable analysis, age (OR 1.03; 95% CI 1.00-1.07; p = 0.021), baseline clinical severity (OR 1.07; 95% CI 1.01-1.15;p = 0.020), and admission blood glucose ≥113 mg/dL (OR 4.63; 95% CI 2.10-10.19; p < 0.001) were independently associated with poor functional outcome.

Admission hyperglycemia predicts poorer 3-month functional outcome, with a low admission glucose threshold (≥113 mg/dL) outperforming a history of type 2 diabetes and falling below current clinical thresholds.