Impact of fasting blood glucose on prognosis after acute large vessel occlusion reperfusion: results from a multicenter analysis

 

So you described something, but DID NOTHING USEFUL THAT WILL HELP STROKE PATIENTS RECOVER. 

Impact of fasting blood glucose on prognosis after acute large vessel occlusion reperfusion: results from a multicenter analysis

Bin Luo^1,2,3†Yi Xiang^4†Fanlei Meng^5†Yubo Wang³Zhenzhong Zhang⁶Hecheng Ren^3*Lin Ma^3*

• ¹Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
• ²Tianjin Neurological Institute, Tianjin Huanhu Hospital, Tianjin, China
• ³Department of Clinical Laboratory, Tianjin Huanhu Hospital, Tianjin, China
• ⁴Department of Neurology, Xianyang Central Hospital, Xianyang, China
• ⁵Department of Neurology, Second Hospital of Tianjin Medical University, Tianjin, China
• ⁶Department of Neurosurgery, Hengshui Fifth People’s Hospital, Hengshui, China

Objective: To analyze the effect of fasting blood glucose levels after reperfusion of acute large vessel occlusion (ALVO) on patient functional prognosis.

Methods: Retrospectively included ALVO patients from three large stroke centers in China, all of whom achieved vascular reperfusion after mechanical thrombectomy or bridging thrombolysis. The prognosis scores of all patients at 90 ± 7 days post-recanalization were categorized into a good prognosis group (mRS 0–2) and a poor prognosis group (mRS 3–6). The relationship between mean blood glucose levels at 72 h post-recanalization and prognosis was explored using multivariable logistic regression analysis. Then we measured the area under the ROC curve for all factors to assess their predictive performance.

Results: (1) Totally 2,056 patients were included in the study, with 1,488 males and 568 females. There were 1,370 patients in the good prognosis group (mRS 0–2) and 686 in the poor prognosis group (mRS 3–6). (2) The two groups exhibited significant differences in terms of age, preoperative mRS score, history of diabetes, and mean fasting blood glucose (MFBG) (p < 0.001). (3) With 90-day mRS as the outcome variable, all independent variables were included in Univariate and multivariate regression analyses analysis, and the results showed that: age, preoperative mRS score, history of diabetes, and MFBG are all independent predictors of prognosis after recanalization of ALVO, with MFBG demonstrating a higher predictive power than the other factors (AUC = 0.644).

Conclusion: Various factors are correlated with the prognosis in patients who have undergone ALVO recanalization. Notably, the MFBG level demonstrates a significant predictive value for outcomes within the first 72 h following the recanalization procedure.

1 Background

Although mechanical thrombectomy (MT) has achieved higher rates of vascular recanalization in patients with acute large vessel occlusion (ALVO), the issue of reperfusion injury to brain tissue after vascular recanalization has always been a challenge that scholars and clinicians cannot avoid. Approximately 20–50% of ALVO patients may experience stress-induced hyperglycemia, caused by the release of cortisol and adrenaline leading to elevated blood glucose levels, a phenomenon commonly seen even in non-diabetic patients (1, 2). Patients undergoing MT procedures need to consider factors such as surgery-related stress, and hyperglycemia has been associated with adverse clinical outcomes in ALVO patients (3–7). Hyperglycemia levels can further exacerbate the hypoxic status of midbrain cells in the ischemic penumbra, leading to increased acidosis, mitochondrial dysfunction, and even failure (8). Besides, elevated blood glucose levels are associated with the formation of free radicals and activation of matrix metalloproteinases, which can further worsen brain edema (9–11). The 2018 American Heart Association/American Stroke Association (AHA/ASA) guidelines recommend (12) targeting blood glucose levels to 140–180 mg/dL (7.8–10.0 mmol/L), but this standard lacks a higher level of objective evidence due to limited supporting data (1).

Our team’s previous research findings showed: hyperglycemia is an independent risk factor for poor prognosis in ALVO patients after vascular recanalization. The good prognosis rate in the low blood glucose group was 1.62 times higher than that in the hyperglycemia group; and for every 1 mmol/L decrease in blood glucose, the rate of poor prognosis decreased by 7.2% [OR: 0.928, 95% CI (0.879, 0.979), p = 0.007] (2). Other studies have shown the opposite: However, other studies have yielded conflicting results, with no significant difference in the 90-day modified Rankin Scale (90ds-mRS) between patients on intensified glucose lowering (4.44–7.22 mmol/L) and patients at standard glucose levels (4.44–9.93 mmol/L) (3–5). Further research is needed to determine whether different blood glucose levels affect the 90ds-mRS in patients.

Taking into account the above factors, we conducted a retrospective study on the fasting blood glucose levels of 2,056 post-MT patients with ALVO from three different medical centers, analyzing the relationship between MFBG levels and 90ds-mRS.

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