Glycated Hemoglobin Value Combined with Initial Glucose Levels for Evaluating Mortality Risk in Patients with Ischemic Stroke.
BACKGROUND
Hyperglycemia is a marker of poor outcome in acute ischemic stroke (IS) patients. We aimed at evaluating the effect of combined HbA1c and first glucose measurement values on 3-month mortality prediction.


METHODS
In a prospective analysis, 1,317 first-ever IS patients with HbA1c values were classified by first glycemia value (<155, 155-199, ≥200 mg/dl). Three-month mortality was analyzed by glycemia category in nondiabetics, diabetics with good previous glucose control (PGC) (HbA1c <7%), and diabetics with poor PGC (HbA1c ≥7.0%).


RESULTS
Mortality at 3 months was 13.1%, with no differences (p = 0.339) between non-diabetes mellitus (DM) (12.3%), good PGC-DM (12.4%), and poor PGC-DM (15.6%) patients. The unadjusted relative risk of 3-month mortality for patients with glucose ≥200 mg/dl was 3.76 (95% CI 1.48-9.56) in non-DM, 6.10 (95% CI 1.76-21.09) in good PGC-DM, and 1.44 (95% CI 0.77-2.69) in poor PGC-DM. Glycemia cutoffs most highly correlated with mortality increased as PGC declined: 107 mg/dl in non-DM, 152 mg/dl in good PGC-DM, and 229 mg/dl in poor PGC-DM patients. Glycemia correlated with stroke severity in nondiabetics and diabetic patients with good PGC, but not in those with poor PGC.


CONCLUSIONS
HbA1c determination combined with first measured glucose value is useful to stratify mortality risk in IS patients: hyperglycemia is a poor prognostic marker in non-DM and DM patients with good PGC; results are inconsistent in poor PGC-DM patients. Our data suggest the relationship between hyperglycemia and poor outcome reflects stress response rather than a deleterious effect of glucose.
Servei de Neurologia, Hospital del Mar, Barcelona, Spain.
Jaume
J
Roquer
Eva
E
Giralt-Steinhauer
Georgina
G
Cerdà
Ana
A
Rodríguez-Campello
Elisa
E
Cuadrado-Godia
Jordi
J
Jiménez-Conde
Rosa Maria
RM
Vivanco-Hidalgo
Carol
C
Soriano
Irene R
IR
Dégano
Angel
A
Ois
D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology; D015415:Biomarkers; D001786:Blood Glucose / Q000032:analysis*; D002545:Brain Ischemia / Q000097:blood* / Q000401:mortality; D015897:Comorbidity; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data
D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin