Association of Stroke Clinical Outcomes with Coexistence of Hyperglycemia and Biomarkers of Inflammation

doi:10.1016/j.jstrokecerebrovasdis.2015.01.028

Journal of Stroke and Cerebrovascular Diseases

Volume 24, Issue 6, June 2015, Pages 1250-1255

https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.01.028 Get rights and content

Background

To investigate the association of short-term clinical outcomes with coexistence of hyperglycemia and elevated biomarkers of inflammation among acute ischemic stroke (AIS) patients.

Methods

We performed a retrospective study of 2675 patients diagnosed with AIS from January 2006 to December 2008. The study outcomes were defined as neurologic deficiency (National Institutes of Health Stroke Scale score ≥5) at discharge or death during hospitalization.

Results

Compared with normoglycemia and without any elevated biomarkers, patients with hyperglycemia, elevated white blood cell (WBC) count, elevated neutrophils ratio (NEUR), and elevated erythrocyte sedimentation rate (ESR) had higher rates of study outcomes (all P < .05). Furthermore, patients with coexistence of hyperglycemia with any of elevated WBC count, NEUR, or ESR were more likely to have study outcomes (all P < .05). Compared with subjects with normoglycaemia and without any elevated biomarker, multivariate adjusted odds ratios (95% confidence interval) of study outcomes associated with hyperglycemia, elevated WBC count, elevated NEUR, elevated ESR, coexistences of hyperglycemia with elevated WBC count, elevated NEUR, and elevated ESR were 1.492 (1.139-1.955), 1.404 (1.048-1.881), 1.897 (1.411-2.551), 2.184 (1.339-3.564), 1.963 (1.337-2.883), 2.544(1.715- 3.775), and 2.687 (1.347-5.363), respectively.

Conclusions

This study indicated that hyperglycemia and elevated biomarkers of inflammation were associated with short-term clinical outcomes, and individuals with coexistence of hyperglycemia and elevated biomarkers of inflammation had higher risk of poor clinical outcomes among AIS patients.

Section snippets

Study Participants

All patients with a clinical diagnosis of AIS admitted to the 4 hospitals in Shandong from January 1, 2006, to December 31, 2008, were potentially eligible for the study. Among 2868 AIS patients admitted to the 4 hospitals during the study period, 2675 had a computed tomography (CT) scan or magnetic resonance imaging (MRI) confirmed ischemic stroke and were included in this analysis. A total of 193 patients were excluded from our analysis because of lack of a CT scan, MRI test, National

Results

A total of 2675 ischemic stroke patients were included in our analysis, there were 2228 patients without study outcomes and 447 patients with study outcomes (19 death and 428 patients with NIHSS ≥5). The median time from onset of symptom to admission was 39.5 hours, and the median duration of hospitalization was 15 days.

Table 1 presents the demographic and clinical characteristics of AIS patients on admission by study outcomes. Those with study outcomes were more likely to have

Discussion

The results of our retrospective study among AIS patients indicated that hyperglycemia and increased levels of inflammation biomarkers such as WBC count, NEUR, ESR, and their coexistences on admission were positively and significantly associated with study outcomes. Patients with higher levels of WBC count, NEUR, and ESR and their coexistences with hyperglycemia were all at a significantly higher risk for the outcomes than those with normoglycaemia and without any elevated biomarkers. In

Acknowledgments

This study is supported by Youth Found of the National Natural Science Foundation of China (grant no. 81102190), Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases and a Project of the Priority Academic Program Development of Jiangsu Higher Education Institutions, China.

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Of 4181 AIS patients included in analyzes, and with group A as the reference, an increasing odds of poor functional outcome was evident across groups B (odds ratio [OR] 1.38, 95 % confidence interval [CI] 1.17−1.63), C (OR 1.26, 95 %CI 0.99−1.60), and D (OR 2.26, 95 %CI 1.79−2.85) (P trend <0.001). Group D patients also had a higher rate of sICH (P trend <0.05). The model fit with the combination of blood glucose and WBC was better than models of their individual components.
Using a combination of blood glucose and WBC provides strong prognostic significance than either alone in thrombolyzed AIS patients.
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Hyperglycemia and hyperosmolality are associated with poor outcomes among acute ischemic stroke (AIS) patients.
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We conducted a retrospective study of AIS patients admitted to the study hospital emergency department between January and December 2014. Hyperglycemia was defined as serum glucose >144 mg/dL, and hyperosmolality was defined as a serum osmolality >295 mOsm/kg. After excluding hypoglycemia and hypoosmolality, the enrolled patients were classified into the following 4 subgroups: normoglycemia-normoosmolality, hyperglycemia-normoosmolality (HGNO), normoglycemia-hyperosmolality (NGHO), and hyperglycemia-normoosmolality (HGHO). The primary outcome was poor neurological status at 6 months, which was defined as a modified Rankin scale score ≥2.
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: The authors have no conflicts of interest to disclose.

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Original ArticleAssociation of Stroke Clinical Outcomes with Coexistence of Hyperglycemia and Biomarkers of Inflammation

Background

Methods

Results

Conclusions

Section snippets

Study Participants

Results

Discussion

Acknowledgments

Lancet Neurol

Lancet Neurol

Gastroenterology

J Stroke Cerebrovasc Dis

J Stroke Cerebrovasc Dis

J Vasc Surg

J Stroke Cerebrovasc Dis

Atherosclerosis

J Diabetes Complications

Proportion of different subtypes of stroke in China

Stroke

Atherosclerosis–an inflammatory disease

N Engl J Med

Blood glucose increases early after stroke onset: a study on serial measurements of blood glucose in acute stroke

Eur J Neurol

Original Article
Association of Stroke Clinical Outcomes with Coexistence of Hyperglycemia and Biomarkers of Inflammation