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Higher admission fasting plasma glucose levels are associated with a poorer short-term neurologic outcome in acute ischemic stroke patients with good collateral circulation

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Abstract

Aims

In this retrospective study, we sought to delineate the collateral circulation status of acute ischemic stroke patients by CT perfusion and evaluate 90-day modified Rankin Scale (mRS) scores of patients with good or poor collaterals and its correlation with admission fasting plasma glucose (FPG).

Methods

We enrolled acute ischemic stroke patients who presented to our hospital 4.5 h within an onset of the first episode between January 2009 and December 2015. Neurological assessment was performed using the 90-day mRS scores (0–2 for a favorable and 3–6 for an unfavorable neurologic outcome). Relative filling time delay (rFTD) was evaluated by CT perfusion scan. The primary outcomes were 90-day mRS scores stratified by good (rFTD ≤ 4 s) versus poor collateral circulation (rFTD > 4 s).

Results

Totally 270 patients were included, and 139 (51.5%) patients achieved a favorable neurologic outcome. One hundred eighty-five (68.5%) patients had good collateral circulation. Significantly greater portions of patients with good collateral circulation (60.5%, 112/185) achieved a favorable neurologic outcome compared to those with poor collateral circulation (31.8%, 27/85) (P < 0.05). Patients with good collateral circulation achieving a favorable neurologic outcome had significantly lower baseline FPG (6.6 ± 1.96) than those with good collateral circulation achieving an unfavorable neurologic outcome (8.12 ± 4.02; P = 0.002). Spearman correlation analysis showed that rFTD significantly correlated with 90-day mRS scores (adjusted r = 0.258; P < 0.001) and admission FPG (r = 0.286; P < 0.001).

Conclusion

Higher admission FPG levels are associated with significantly higher rates of unfavorable neurologic outcome of acute ischemic stroke patients with good collateral circulation. FPG and rFTD may serve as useful predictors of short-term patient outcome and could be used for risk stratification in clinical decision making.

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Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233, China

    Feng Wang & Yuwu Zhao

  2. Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3050, Australia

    Feng Wang, Beisi Jiang, Lasheta Kanesan & Bernard Yan

  3. Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China

    Beisi Jiang

Authors
  1. Feng Wang
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  2. Beisi Jiang
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  3. Lasheta Kanesan
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  4. Yuwu Zhao
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  5. Bernard Yan
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Corresponding authors

Correspondence to Yuwu Zhao or Bernard Yan.

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Conflict of interest

The authors declare that they have no conflict of interest.

Human and Animal Rights disclosure

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Melbourne Health Human Research Ethics Committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Patient consent was not required because of the retrospective nature of the study.

Additional information

Managed by Antonio Secchi.

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592_2018_1139_MOESM1_ESM.tif

Supplementary Figure 1 ROC curve of baseline FPG for 90-day mortality in diabetic patients with good collateral circulation. (TIFF 299 kb)

Supplementary material 2 (DOCX 26 kb)

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Wang, F., Jiang, B., Kanesan, L. et al. Higher admission fasting plasma glucose levels are associated with a poorer short-term neurologic outcome in acute ischemic stroke patients with good collateral circulation. Acta Diabetol 55, 703–714 (2018). https://doi.org/10.1007/s00592-018-1139-6

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  • DOI: https://doi.org/10.1007/s00592-018-1139-6

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