Impact of Glycosylated Hemoglobin on the Prognosis of Patients with Acute Ischemic Stroke Treated with Arterial Thrombolysis

Authors

  • Wentong Ling Department of Neurology, Zhongshan City People’s Hospital, Zhongshan, China
  • Qiong Chen Department of Clinical Medicine, Zhongshan City People’s Hospital, Zhongshan, China
  • Pu Huang Department of Neurology, Zhongshan City People’s Hospital, Zhongshan, China
  • Dengke Han Department of Clinical Medicine, Zhongshan City People’s Hospital, Zhongshan, China
  • Wenjun Wu Department of Neurology, Zhongshan City People’s Hospital, Zhongshan, China

DOI:

https://doi.org/10.1532/hsf.2929

Keywords:

arterial thrombolysis, acute ischemic stroke, glycosylated hemoglobin

Abstract

Background: To investigate the impact of glycosylated hemoglobin (HbA1c) on the prognosis of patients with acute ischemic stroke (AIS) treated with intra-arterial thrombolysis (IAT).

Methods: The clinical data of 136 patients with AIS treated with IAT at the Zhongshan City People’s Hospital were retrospectively analyzed. The patients were divided into a high HbA1c group (HHbA1c) (≥6.5%) and a normal HbA1c group (NHbA1c) (<6.5%). According to National Institutes of Health Stroke Scale (NIHSS) score after thrombolysis, patients were divided into a good prognosis group (GP) (≥4 or <4 points reduction) and a poor prognosis group (PP) (≤4 or >4 points reduction).

Results: There were significant differences in the HbA1c and glucose levels, NIHSS scores at admission and at discharge, complication rates, and mortality rates between groups HHbA1c and NHbA1c (P < .05) and between groups GP and PP (P < .05). The multivariate logistic regression analysis showed that HbA1c level (odds ratio [OR] 0.717; 95% confidence interval [CI] 0.545 to 0.889) and NIHSS score at admission (OR 0.894; 95% CI 0.814 to 0.982) were risk factors for neurological improvement in IAT-treated patients with AIS.

Conclusions: HbA1c level is associated with neurological function improvement in IAT-treated patients with AIS and can be used as a serological indicator of poor prognosis.

References

Ahmed N, Dávalos A, Eriksson N, et al. 2010. Association of admission blood glucose and outcome in patients treated with intravenous thrombolysis: Results from the Safe Implementation of Treatments in Stroke International Stroke Thrombolysis Register (SITS-ISTR). Arch Neurol 67:1123-1130.

Arnold M, Mattle S, Galimanis A, et al. 2014. Impact of admission glucose and diabetes on recanalization and outcome after intra-arterial thrombolysis for ischaemic stroke. Int J Stroke 9:985-991.

Braemswig TB, Nolte CH, Fiebach JB, et al. 2017. Early new ischemic lesions located outside the initially affected vascular territory appear more often in stroke patients with elevated hemoglobin (HbA1c). Front Neurol 8:606.

Bruno A, Levine SR, Frankel MR, et al. 2002. Admission glucose levels and clinical outcomes in the NINDS rt-PA Stroke Trial. Neurology 59:669-674.

Desilles JP, Meseguer E, Labreuche J, et al. 2013. Diabetes mellitus, admission glucose, and outcomes after stroke thrombolysis: A registry and systematic review. Stroke 44:1915-1923.

Gao Y, Jiang L, Wang H, et al. 2016. Association between elevated hemoglobinA1c levels and the outcomes of patients with small-artery occlusion: A hospital-based study. PLoS One 11:e0160223.

Hallevi H, Barreto AD, Liebeskind DS, et al. 2009. Identifying patients at high risk for poor outcome after intra-arterial therapy for acute ischemic stroke. Stroke 40:1780-1785.

Jauch EC, Saver JL, Adams HP Jr, et al. 2013. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 44:870-947.

Jia Q, Zhao X, Wang C, et al. 2011. Diabetes and poor outcomes within 6 months after acute ischemic stroke: the China National Stroke Registry. Stroke 42:2758-2762.

Kamouchi M, Matsuki T, Hata J, et al. 2011. Prestroke glycemic control is associated with the functional outcome in acute ischemic stroke: The Fukuoka Stroke Registry. Stroke 42:2788-2794.

Kruyt ND, Biessels GJ, DeVries JH, et al. 2010. Hyperglycemia in acute ischemic stroke: Pathophysiology and clinical management. Nat Rev Neurol 6:145-155.

Lee KJ, Lee JS, Jung KH. 2018. Interactive effect of acute and chronic glycemic indexes for severity in acute ischemic stroke patients. BMC Neurol 18:105.

O’Donnell MJ, Chin SL, Rangarajan S, et al. 2016. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): A case-control study. Lancet 388:761-765.

Pandolfi A, Giaccari A, Cilli C, et al. 2001. Acute hyperglycemia and acute hyperinsulinemia decrease plasma fibrinolytic activity and increase plasminogen activator inhibitor type 1 in the rat. Acta Diabetol 38:71-76.

Ribo M, Molina C, Montaner J, et al. 2005. Acute hyperglycemia state is associated with lower tPA-induced recanalization rates in stroke patients. Stroke 36:1705-1709.

Roquer J, Rodriguez-Campello A, Cuadrado-Godia E, et al. 2014. The role of HbA1c determination in detecting unknown glucose disturbances in ischemic stroke. PLoS One 9:e109960.

Wechsler LR, Roberts R, Furlan AJ, et al. 2003. Factors influencing outcome and treatment effect in PROACT II. Stroke 34:1224-1229.

Wu S, Shi Y, Wang C, et al. 2013. Glycated hemoglobin independently predicts stroke recurrence within one year after acute first-ever non-cardioembolic strokes onset in a Chinese cohort study. PLoS One 8:e80690.

Wu S, Wang C, Jia Q, et al. 2014. HbA1c is associated with increased all-cause mortality in the first year after acute ischemic stroke. Neurol Res 36:444-452.

Published

2020-07-02

How to Cite

Ling, W., Chen, Q., Huang, P., Han, D., & Wu, W. (2020). Impact of Glycosylated Hemoglobin on the Prognosis of Patients with Acute Ischemic Stroke Treated with Arterial Thrombolysis. The Heart Surgery Forum, 23(4), E447-E451. https://doi.org/10.1532/hsf.2929

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