title: HbA1c is associated with increased all-cause mortality in the first year after acute ischemic stroke.
abstract: OBJECTIVE
  To assess the association between baseline HbA1c and the poor outcomes within 1 year after acute ischemic stroke.
  
  
  METHODS
  Acute ischemic stroke patients with HbA1c values at baseline (n  =  2186) were selected from the abnormal glucose regulation in patients with acute stroke across China study (ACROSS). Logistic regressions were performed to assess the association between HbA1c quartiles (<5.5% [37 mmol/mol], 5.5 to <6.1% [37 to <43 mmol/mol], 6.1 to <7.2% [43 to <55 mmol/mol], and ≥ 7.2% [≥ 55 mmol/mol]) and the poor outcomes within 1 year. Poor outcomes were defined as all-cause mortality (modified Rankin scale [mRS]  =  6) and poor functional outcome (mRS [2-6]).
  
  
  RESULTS
  The risk for all-cause mortality was significantly increased in HbA1c level >5.5% [>37 mmol/mol] when compared to HbA1c quartile <5.5% [<37 mmol/mol] and dramatically increased to two to three times higher in the highest HbA1c quartile ≥ 7.2% [>55 mmol/mol] (1-year all-cause mortality model, odds ratios [ORs] were 1.07, 1.01, and 2.45, P for trend 0.009). After the further analysis with previous diabetes mellitus (DM) and post-stroke insulin use stratified, the risk of mortality was increased across the HbA1c levels (P for trend 0.020) and dramatically augmented in HbA1c ≥ 7.2% [>55 mmol/mol] in patients without a history of DM and without post-stroke insulin use.
  
  
  CONCLUSIONS
  Elevated HbA1c (from 5.5% [37 mmol/mol]) presenting pre-stroke glycemia status has a significant trend in increasing the risk of 1-year all-cause mortality. HbA1c ≥ 7.2% (>55 mmol/mol) is an independent risk predictor for 1-year all-cause mortality after acute first-ever ischemic stroke. Such an association might be altered by glycometabolism status.
authors.forename: Shuolin
authors.initials: S
authors.lastname: Wu
authors.forename: Chunxue
authors.initials: C
authors.lastname: Wang
authors.forename: Qian
authors.initials: Q
authors.lastname: Jia
authors.forename: Gaifen
authors.initials: G
authors.lastname: Liu
authors.forename: Kolin
authors.initials: K
authors.lastname: Hoff
authors.forename: Xianwei
authors.initials: X
authors.lastname: Wang
authors.forename: Anxin
authors.initials: A
authors.lastname: Wang
authors.forename: Chunjuan
authors.initials: C
authors.lastname: Wang
authors.forename: Xingquan
authors.initials: X
authors.lastname: Zhao
authors.forename: Yilong
authors.initials: Y
authors.lastname: Wang
authors.forename: Liping
authors.initials: L
authors.lastname: Liu
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D002545:Brain Ischemia / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D002681:China / Q000453:epidemiology; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012306:Risk; D020521:Stroke / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: Diabetes mellitus,; Ischemic stroke,; Mortality,; Risk factors