Document Type : Original Article
Authors
- Ghasem Farahmand 1
- Atefeh Behkar 2
- Mojtaba Shahbazi 1
- Reza Doshmanziari 3
- Safoura Sadat Jazaery 4
- Sara Pouyanmanouchehri 1
- Abbas Tafakhori 1
- Sara Ranji 1
1 Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
2 Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
3 School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
4 Internal Medicine Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Background: High fasting blood sugar (FBS), hemoglobin A1C (HbA1c), and random glucose levels have been associated with poor neurological outcomes in patients with acute ischemic stroke (AIS). This study aimed to determine the prognostic value of HbA1c in predicting stroke’s functional outcome.
Methods: In this prospective cohort study, one-hundred patients with AIS who were admitted to the Imam Khomeini Hospital Complex, Tehran, Iran, from March 2019 to February 2020, within 72 hours of symptom onset were included. A 3-month modified Rankin Scale (mRS) was used to assess the functional outcome. Patients were divided into 3 groups based on the HbA1c levels: low HbA1c level (≤ 5.6%), moderate HbA1c level (5.7%-6.4%), and high HbA1c level (≥ 6.5%). Using chi-square test, t-test, analysis of variance (ANOVA), multiple logistic regression, and receiver operating characteristic (ROC) analysis, we studied the association and prognostic value of HbA1c levels and 3-month mRS as an outcome. The significance level was considered as P < 0.05.
Results: We included 100 patients (53 men) with a mean age of 71.55 ± 11.94 years. The mean HbA1c, National Institutes of Health Stroke Scale (NIHSS), and mRS scores at admission were 6.98 ± 2.34, 8.27 ± 4.40, and 3.01 ± 1.47, respectively. Three-month mRS scores were significantly higher in patients with high HbA1c levels (3.43 ± 1.88) compared with low HbA1c levels (0.43 ± 0.61) and moderate HbA1c levels (1.72 ± 1.45) (P < 0.001).
ROC analysis showed an area under the curve (AUC) of 0.897, and a serum HbA1c level at admission threshold of 6.15% had a sensitivity of 95.2% and a specificity of 77.6% to predict the poor outcome [95% confidence interval (CI): 0.837-0.957].
Conclusion: Our findings indicated that serum HbA1c levels at admission could be a valuable predictor of the functional outcome of patients with AIS.
Keywords
Main Subjects
- Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, et al. Global, regional, and national burden of stroke and its risk factors, 1990–2019:
A systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20(10): 795-820. - Lau LH, Lew J, Borschmann K, Thijs V, Ekinci EI. Prevalence of diabetes and its effects on stroke outcomes: A meta-analysis and literature review. J Diabetes Investig 2019; 10(3): 780-92.
- Spronk E, Sykes G, Falcione S, Munsterman D, Joy T, Kamtchum-Tatuene J, et al. Hemorrhagic Transformation in Ischemic Stroke and the Role of Inflammation. Front Neurol 2021; 12: 661955.
- Weir CJ, Murray GD, Dyker AG, Lees KR. Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long-term follow up study. BMJ 1997; 314(7090): 1303-6.
- Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010; 375(9733): 2215-22.
- O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010; 376(9735): 112-23.
- Kidwell CS, Warach S. Acute ischemic cerebrovascular syndrome: diagnostic criteria. Stroke 2003; 34(12): 2995-8.
- Kruyt ND, Biessels GJ, Devries JH, Roos YB. Hyperglycemia in acute ischemic stroke: pathophysiology and clinical management. Nat Rev Neurol 2010; 6(3): 145-55.
- Bao Y, Gu D. Glycated Hemoglobin as a Marker for Predicting Outcomes of Patients With Stroke (Ischemic and Hemorrhagic): A Systematic Review and Meta-Analysis. Front Neurol 2021; 12: 642899.
- Kamouchi M, Matsuki T, Hata J, Kuwashiro T, Ago T, Sambongi Y, et al. Prestroke glycemic control is associated with the functional outcome in acute ischemic stroke: the Fukuoka Stroke Registry. Stroke 2011; 42(10): 2788-94.
- Sherwani SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of HbA1c Test in Diagnosis and Prognosis of Diabetic Patients. Biomark Insights 2016; 11: 95-104.
- Sacco RL, Benjamin EJ, Broderick JP, Dyken M, Easton JD, Feinberg WM, et al. Risk factors. Stroke 1997; 28(7): 1507-17.
- Sung JY, Chen CI, Hsieh YC, Chen YR, Wu HC, Chan L, et al. Comparison of admission random glucose, fasting glucose, and glycated hemoglobin in predicting the neurological outcome of acute ischemic stroke: a retrospective study. PeerJ 2017; 5: e2948.
)