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：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

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, 张学良, 李丞, 等. 2 型糖尿病周围神经病变风险的列线图预测模型研究. 中国全科医学, 2022, 25(6): 675-681.
4.	陈月富, 苏斌儒, 罗成宏, 等. 空腹血糖水平与进展性缺血性脑卒中的相关性研究. 中华老年心脑血管病杂志, 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.	王静悦, 彭延波, 孙博, 等. 急性脑梗死并发应激性高血糖的危险因素分析及对认知预后的影响. 中国综合临床, 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.	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南 2018. 中华神经科杂志, 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.	蔡颖源, 陆小伟. 老年急性岛叶梗死与应激性高血糖发生风险的相关性. 实用老年医学, 2021, 35(11): 1126-1130.
14.	李政, 张佳慧, 罗云. 脑梗死急性期血糖相关指标与卒中严重程度的相关性. 中国临床研究, 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.	周邑东, 袁怀武, 计仁杰, 等. 缺血性卒中后应激性高血糖与早期血管性认知功能障碍的相关性. 中国医学科学院学报, 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.	吴伏鹏. 应激性血糖升高比值对急性心力衰竭患者预后研究. 上海: 上海交通大学, 2020.
23.	王静悦, 孙博, 彭延波, 等. 应激性高血糖比率与前循环穿支动脉硬化性脑梗死早期认知功能障碍的相关性研究. 中华全科医学, 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.	梁亚丽, 赵海港, 项广宇. 应激性高血糖比值预测急性缺血性脑卒中患者溶栓治疗后 1 年不良预后的价值. 诊断学理论与实践, 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.	夏智丽, 高程洁, 高亚洁, 等. 应激性血糖升高比值对急性心肌梗死患者预后的评估价值. 上海交通大学学报(医学版), 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.	张东, 李治璋, 马瑞楠, 等. 应激性高血糖比值与急性缺血性卒中患者临床预后的相关性研究. 中国卒中杂志, 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, 张学良, 李丞, 等. 2 型糖尿病周围神经病变风险的列线图预测模型研究. 中国全科医学, 2022, 25(6): 675-681.
4. 陈月富, 苏斌儒, 罗成宏, 等. 空腹血糖水平与进展性缺血性脑卒中的相关性研究. 中华老年心脑血管病杂志, 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. 王静悦, 彭延波, 孙博, 等. 急性脑梗死并发应激性高血糖的危险因素分析及对认知预后的影响. 中国综合临床, 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. 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南 2018. 中华神经科杂志, 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. 蔡颖源, 陆小伟. 老年急性岛叶梗死与应激性高血糖发生风险的相关性. 实用老年医学, 2021, 35(11): 1126-1130.
14. 李政, 张佳慧, 罗云. 脑梗死急性期血糖相关指标与卒中严重程度的相关性. 中国临床研究, 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. 周邑东, 袁怀武, 计仁杰, 等. 缺血性卒中后应激性高血糖与早期血管性认知功能障碍的相关性. 中国医学科学院学报, 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. 吴伏鹏. 应激性血糖升高比值对急性心力衰竭患者预后研究. 上海: 上海交通大学, 2020.
23. 王静悦, 孙博, 彭延波, 等. 应激性高血糖比率与前循环穿支动脉硬化性脑梗死早期认知功能障碍的相关性研究. 中华全科医学, 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. 梁亚丽, 赵海港, 项广宇. 应激性高血糖比值预测急性缺血性脑卒中患者溶栓治疗后 1 年不良预后的价值. 诊断学理论与实践, 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. 夏智丽, 高程洁, 高亚洁, 等. 应激性血糖升高比值对急性心肌梗死患者预后的评估价值. 上海交通大学学报(医学版), 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. 张东, 李治璋, 马瑞楠, 等. 应激性高血糖比值与急性缺血性卒中患者临床预后的相关性研究. 中国卒中杂志, 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

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content