Correlation analysis and predictive value of stress hyperglycemia ratio for clinical prognosis of acute ischemic stroke_West China Medical Journal

Authors：

GAO Kaiqian ¹ , JU Huidong ² , CHEN Can ¹ ,  LIANG Jing ¹ , WEI Xiaodi ¹ , HU Yanfang ³ , YANG Yu ¹

1. Department of Internal Medicine, Shijiazhuang Fifth Hospital, Shijiazhuang, Heibei 050021, P. R. China;
2. School of Biomedicine, Shijiazhuang University, Shijiazhuang, Heibei 050035, P. R. China;
3. Department of Infection, Shijiazhuang Fifth Hospital, Shijiazhuang, Heibei 050021, P. R. China;

Corresponding?author：

LIANG Jing, Email: 148126395@qq.com

Keywords：

Stress hyperglycemia ratio; stress blood glucose; acute ischemic stroke; prognosis

DOI：

10.7507/1002-0179.202305040

Video：

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Objective To investigate the correlation between stress hyperglycemia ratio (SHR) and acute ischemic stroke (AIS) 1-year prognosis, to provide more clinical basis to improve the prognosis of AIS patients and to target and control the influencing factors. Methods The patients with AIS diagnosed for the first time and received treatment at the Shijiazhuang Fifth Hospital between May 2019 and January 2022 were retrospectively and continuously included. According to the Modified Rankin Scale score 1-year after the onset of the disease, the patients were divided into a good prognosis group and a poor prognosis group. Also the patients were divided into 2 groups based on the median of SHR. The correlation between SHR and stress blood glucose was analyzed, and the factors affecting the prognosis of AIS patients were identified. The predictive value of SHR and stress blood glucose on the prognosis of AIS patients was compared using receiver operating characteristic. Results A total of 206 patients were included. Among them, there were 125 cases (60.7%) in the good prognosis group and 81 cases (39.3%) in the poor prognosis group. The median SHR (lower quartile, upper quartile) is 1.20 (1.08, 1.33). There were statistically significant differences between the two groups in the scores of the National Institutes of Health Stroke Scale, diabetes history, hypertension history, low-density lipoprotein cholesterol, stress blood glucose, age, SHR and SHR classification (P<0.05). There was no statistically significant difference in the other indicators compared between the two groups (P＞0.05). Stress blood glucose was positively correlated with SHR (7.95±1.78 vs. 1.21±0.19; r=0.294, P<0.001). Multivariate logistic analysis showed that stress blood glucose and SHR were independent factors influencing the 1-year prognosis of AIS patients (P<0.05), and the interaction between SHR and diabetes was not significant (P>0.05) After adjusting for confounding factors, the area under the receiver operating characteristic curve of SHR for the prognosis of AIS patients was higher than that of stress blood glucose [0.682 (0.614, 0.745) vs .0.585 (0.515, 0.653); Z=2.042, P=0.041]. Conclusions SHR and stress blood glucose are independent risk factors for 1-year prognosis in AIS patients. However, SHR has a better predictive value for 1-year prognosis in AIS patients than stress blood glucose. Whether the patient has diabetes or not, the impact of SHR on the prognosis of AIS patients is consistent.

Citation： GAO Kaiqian, JU Huidong, CHEN Can, LIANG Jing, WEI Xiaodi, HU Yanfang, YANG Yu. Correlation analysis and predictive value of stress hyperglycemia ratio for clinical prognosis of acute ischemic stroke. West China Medical Journal, 2024, 39(1): 30-35. doi: 10.7507/1002-0179.202305040 Copy

1.	Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults. Circulation, 2017, 135(8): 759-771.
2.	Lu H, Guo Z, Liu J, et al. Trends in stroke incidence among elderly low-income residents of rural China: a population-based study from 1992 to 2016. Aging (Albany NY), 2018, 10(11): 3438-3449.
3.	李永生, 張學良, 李丞, 等. 2 型糖尿病周圍神經病變風險的列線圖預測模型研究. 中國全科醫學, 2022, 25(6): 675-681.
4.	陳月富, 蘇斌儒, 羅成宏, 等. 空腹血糖水平與進展性缺血性腦卒中的相關性研究. 中華老年心腦血管病雜志, 2016, 18(7): 719-721.
5.	Cardoso CRL, Leite NC, Moram CBM, et al. Long-term visit-to-visit glycemic variability as predictor of micro- and macrovascular complications in patients with type 2 diabetes: The rio de janeiro type 2 diabetes cohort study. Cardiovasc Diabetol, 2018, 17(1): 33.
6.	王靜悅, 彭延波, 孫博, 等. 急性腦梗死并發應激性高血糖的危險因素分析及對認知預后的影響. 中國綜合臨床, 2020, 36(6): 513-519.
7.	Yoon JE, Sunwoo JS, Kim JS, et al. Poststroke glycemic variability increased recurrent cardiovascular events in diabetic patients. J Diabetes Complications, 2017, 31(2): 390-394.
8.	Lee SH, Kim Y, Park SY, et al. Pre-stroke glycemic variability estimated by glycated albumin is associated with early neurological deterioration and poor functional outcome in prediabetic patients with acute ischemic stroke. Cerebrovasc Dis, 2021, 50(1): 26-33.
9.	Tziomalos K, Dimitriou P, Bouziana S D, et al. Stress hyperglycemia and acute ischemic stroke in-hospital outcome. Metabolism, 2017, 67: 99-105.
10.	中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組. 中國急性缺血性腦卒中診治指南 2018. 中華神經科雜志, 2018, 51(9): 666-682.
11.	Roberts GW, Quinn SJ, Valentine N, et al. Relative hyperglycemia, a marker of critical illness: introducing the stress hyperglycemia ratio. J Clin Endocrinol Metab, 2015, 100(12): 4490-4497.
12.	Liu B, Chen Y, Yu L, et al. Stress hyperglycemia ratio is associated with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission. J Diabetes, 2023, 15(7): 545-556.
13.	蔡穎源, 陸小偉. 老年急性島葉梗死與應激性高血糖發生風險的相關性. 實用老年醫學, 2021, 35(11): 1126-1130.
14.	李政, 張佳慧, 羅云. 腦梗死急性期血糖相關指標與卒中嚴重程度的相關性. 中國臨床研究, 2019, 32(5): 620-623.
15.	Chen G, Ren J, Huang H, et al. Admission random blood glucose, fasting blood glucose, stress hyperglycemia ratio, and functional outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis. Front Aging Neurosci, 2022, 14: 782282.
16.	Zhu B, Pan Y, Jing J, et al. Stress hyperglycemia and outcome of non-diabetic patients after acute ischemic stroke. Front Neurol, 2019, 10: 1003.
17.	Yang Y, Kim TH, Yoon KH, et al. The stress hyperglycemia ratio, an index of relative hyperglycemia, as a predictor of clinical outcomes after percutaneous coronary intervention. Int J Cardiol, 2017, 241: 57-63.
18.	Xu RB, Kong X, Xu BP, et al. Longitudinal association between fasting blood glucose concentrations and first stroke in hypertensive adults in China: effect of folic acid intervention. Am J Clin Nutr, 2017, 105(3): 564-570.
19.	周邑東, 袁懷武, 計仁杰, 等. 缺血性卒中后應激性高血糖與早期血管性認知功能障礙的相關性. 中國醫學科學院學報, 2017, 39(6): 749-755.
20.	Nair SS, Sylaja PN, Sreedharan SE, et al. Maintenance of normoglycemia may improve outcome in acute ischemic stroke. Ann Indian Acad Neurol, 2017, 20(2): 122-126.
21.	Fabbri A, Marchesini G, Benazzi B, et al. Stress hyperglycemia and mortality in subjects with diabetes and sepsis. Crit Care Explor, 2020, 2(7): e0152.
22.	吳伏鵬. 應激性血糖升高比值對急性心力衰竭患者預后研究. 上海: 上海交通大學, 2020.
23.	王靜悅, 孫博, 彭延波, 等. 應激性高血糖比率與前循環穿支動脈硬化性腦梗死早期認知功能障礙的相關性研究. 中華全科醫學, 2021, 19(6): 908-912.
24.	Chen X, Liu Z, Miao J, et al. High stress hyperglycemia ratio predicts poor outcome after mechanical thrombectomy for ischemic stroke. J Stroke Cerebrovasc Dis, 2019, 28(6): 1668-1673.
25.	Li J, Quan K, Wang Y, et al. Effect of stress hyperglycemia on neurological deficit and mortality in the acute ischemic stroke people with and without diabetes. Front Neurol, 2020, 11: 576895.
26.	梁亞麗, 趙海港, 項廣宇. 應激性高血糖比值預測急性缺血性腦卒中患者溶栓治療后 1 年不良預后的價值. 診斷學理論與實踐, 2021, 20(6): 562-566.
27.	Roberts G, Sires J, Chen A, et al. A comparison of the stress hyperglycemia ratio, glycemic gap, and glucose to assess the impact of stress-induced hyperglycemia on ischemic stroke outcome. J Diabetes, 2021, 13(12): 1034-1042.
28.	夏智麗, 高程潔, 高亞潔, 等. 應激性血糖升高比值對急性心肌梗死患者預后的評估價值. 上海交通大學學報(醫學版), 2019, 39(3): 309-315.
29.	Marenzi G, Cosentino N, Milazzo V, et al. Prognostic value of the acute-to-chronic glycemic ratio at admission in acute myocardial infarction: a prospective study. Diabetes Care, 2018, 41(4): 847-853.
30.	張東, 李治璋, 馬瑞楠, 等. 應激性高血糖比值與急性缺血性卒中患者臨床預后的相關性研究. 中國卒中雜志, 2022, 17(5): 483-490.

1. Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults. Circulation, 2017, 135(8): 759-771.
2. Lu H, Guo Z, Liu J, et al. Trends in stroke incidence among elderly low-income residents of rural China: a population-based study from 1992 to 2016. Aging (Albany NY), 2018, 10(11): 3438-3449.
3. 李永生, 張學良, 李丞, 等. 2 型糖尿病周圍神經病變風險的列線圖預測模型研究. 中國全科醫學, 2022, 25(6): 675-681.
4. 陳月富, 蘇斌儒, 羅成宏, 等. 空腹血糖水平與進展性缺血性腦卒中的相關性研究. 中華老年心腦血管病雜志, 2016, 18(7): 719-721.
5. Cardoso CRL, Leite NC, Moram CBM, et al. Long-term visit-to-visit glycemic variability as predictor of micro- and macrovascular complications in patients with type 2 diabetes: The rio de janeiro type 2 diabetes cohort study. Cardiovasc Diabetol, 2018, 17(1): 33.
6. 王靜悅, 彭延波, 孫博, 等. 急性腦梗死并發應激性高血糖的危險因素分析及對認知預后的影響. 中國綜合臨床, 2020, 36(6): 513-519.
7. Yoon JE, Sunwoo JS, Kim JS, et al. Poststroke glycemic variability increased recurrent cardiovascular events in diabetic patients. J Diabetes Complications, 2017, 31(2): 390-394.
8. Lee SH, Kim Y, Park SY, et al. Pre-stroke glycemic variability estimated by glycated albumin is associated with early neurological deterioration and poor functional outcome in prediabetic patients with acute ischemic stroke. Cerebrovasc Dis, 2021, 50(1): 26-33.
9. Tziomalos K, Dimitriou P, Bouziana S D, et al. Stress hyperglycemia and acute ischemic stroke in-hospital outcome. Metabolism, 2017, 67: 99-105.
10. 中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組. 中國急性缺血性腦卒中診治指南 2018. 中華神經科雜志, 2018, 51(9): 666-682.
11. Roberts GW, Quinn SJ, Valentine N, et al. Relative hyperglycemia, a marker of critical illness: introducing the stress hyperglycemia ratio. J Clin Endocrinol Metab, 2015, 100(12): 4490-4497.
12. Liu B, Chen Y, Yu L, et al. Stress hyperglycemia ratio is associated with systemic inflammation and clinical outcomes in diabetic inpatients with pneumonia on admission. J Diabetes, 2023, 15(7): 545-556.
13. 蔡穎源, 陸小偉. 老年急性島葉梗死與應激性高血糖發生風險的相關性. 實用老年醫學, 2021, 35(11): 1126-1130.
14. 李政, 張佳慧, 羅云. 腦梗死急性期血糖相關指標與卒中嚴重程度的相關性. 中國臨床研究, 2019, 32(5): 620-623.
15. Chen G, Ren J, Huang H, et al. Admission random blood glucose, fasting blood glucose, stress hyperglycemia ratio, and functional outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis. Front Aging Neurosci, 2022, 14: 782282.
16. Zhu B, Pan Y, Jing J, et al. Stress hyperglycemia and outcome of non-diabetic patients after acute ischemic stroke. Front Neurol, 2019, 10: 1003.
17. Yang Y, Kim TH, Yoon KH, et al. The stress hyperglycemia ratio, an index of relative hyperglycemia, as a predictor of clinical outcomes after percutaneous coronary intervention. Int J Cardiol, 2017, 241: 57-63.
18. Xu RB, Kong X, Xu BP, et al. Longitudinal association between fasting blood glucose concentrations and first stroke in hypertensive adults in China: effect of folic acid intervention. Am J Clin Nutr, 2017, 105(3): 564-570.
19. 周邑東, 袁懷武, 計仁杰, 等. 缺血性卒中后應激性高血糖與早期血管性認知功能障礙的相關性. 中國醫學科學院學報, 2017, 39(6): 749-755.
20. Nair SS, Sylaja PN, Sreedharan SE, et al. Maintenance of normoglycemia may improve outcome in acute ischemic stroke. Ann Indian Acad Neurol, 2017, 20(2): 122-126.
21. Fabbri A, Marchesini G, Benazzi B, et al. Stress hyperglycemia and mortality in subjects with diabetes and sepsis. Crit Care Explor, 2020, 2(7): e0152.
22. 吳伏鵬. 應激性血糖升高比值對急性心力衰竭患者預后研究. 上海: 上海交通大學, 2020.
23. 王靜悅, 孫博, 彭延波, 等. 應激性高血糖比率與前循環穿支動脈硬化性腦梗死早期認知功能障礙的相關性研究. 中華全科醫學, 2021, 19(6): 908-912.
24. Chen X, Liu Z, Miao J, et al. High stress hyperglycemia ratio predicts poor outcome after mechanical thrombectomy for ischemic stroke. J Stroke Cerebrovasc Dis, 2019, 28(6): 1668-1673.
25. Li J, Quan K, Wang Y, et al. Effect of stress hyperglycemia on neurological deficit and mortality in the acute ischemic stroke people with and without diabetes. Front Neurol, 2020, 11: 576895.
26. 梁亞麗, 趙海港, 項廣宇. 應激性高血糖比值預測急性缺血性腦卒中患者溶栓治療后 1 年不良預后的價值. 診斷學理論與實踐, 2021, 20(6): 562-566.
27. Roberts G, Sires J, Chen A, et al. A comparison of the stress hyperglycemia ratio, glycemic gap, and glucose to assess the impact of stress-induced hyperglycemia on ischemic stroke outcome. J Diabetes, 2021, 13(12): 1034-1042.
28. 夏智麗, 高程潔, 高亞潔, 等. 應激性血糖升高比值對急性心肌梗死患者預后的評估價值. 上海交通大學學報(醫學版), 2019, 39(3): 309-315.
29. Marenzi G, Cosentino N, Milazzo V, et al. Prognostic value of the acute-to-chronic glycemic ratio at admission in acute myocardial infarction: a prospective study. Diabetes Care, 2018, 41(4): 847-853.
30. 張東, 李治璋, 馬瑞楠, 等. 應激性高血糖比值與急性缺血性卒中患者臨床預后的相關性研究. 中國卒中雜志, 2022, 17(5): 483-490.

West China Medical Journal

Correlation analysis and predictive value of stress hyperglycemia ratio for clinical prognosis of acute ischemic stroke

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