Differential effects of admission glucose on outcomes in large ischemic stroke based on treatment modality and clinical characteristics: a prospective cohort study
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Clinical evidence of admission glucose effects in large ischemic stroke remains limited, with unclear optimal approaches for identifying patients who would benefit from glucose management, particularly regarding how hyperglycemia effects vary across treatment modalities and clinical characteristics. METHODS: This prospective multicenter registry included 725 patients with large ischemic stroke (ASPECTS ≤5) and available admission glucose data from 745 patients across 38 centers. The primary outcome was the modified Rankin Scale score at 90 days (range 0-6; higher scores indicate greater disability). Secondary outcomes included moderate neurological outcomes (mRS 0-3), favorable neurological outcomes (mRS 0-2), while the primary safety outcome was 90-day mortality. RESULTS: When admission glucose was analyzed as a continuous variable, higher glucose levels were observed to shift the modified Rankin Scale score distribution towards a less favorable outcome (adjusted OR(aOR), 0.83; 95% CI, 0.78 to 0.89; P < 0.001), with an increase in 90-day mortality (aOR, 1.20; 95% CI, 1.11 to 1.29; P < 0.001). These findings were supported by secondary outcomes. Significant interactions were observed between glucose and treatment modality (P = 0.003), collateral circulation status (P = 0.013), stroke etiology (P < 0.001), and atrial fibrillation (P = 0.018). The adverse effects of hyperglycemia were most pronounced in patients receiving endovascular treatment (EVT), those with atrial fibrillation, poor collateral circulation, and stroke etiology. Critical glucose thresholds were identified at 10.15 mmol/L for moderate neurological outcomes and 7.83 mmol/L for mortality in high-susceptibility subgroups. CONCLUSIONS: Admission glucose exhibits differential impacts based on individual patient characteristics, revealing distinct glycemic susceptibility profiles. These findings demonstrate treatment-dependent glucose effects, with amplified adverse associations in EVT patients and those with high-susceptibility clinical features. Recognition of differential glycemic susceptibility provides mechanistic rationale for personalized glucose management strategies and supports precision medicine approaches in acute stroke.
Source: International Journal of Surgery
Authors: Xiaolei Shi, Xu Xu, Zhixian Ye, Chunye Chen, Shihai Yang, Rongzong Li, Jiaxing Song, Shitao Fan, Jie Yang, Linyu Li, Chengsong Yue, Jiacheng Huang, Wenzhe Sun, Dahong Yang, Gaoming Li, Nizhen Yu, Chang Liu, Boyu Chen, Zhenxuan Tian, Jinfu Ma, Zhixi Wang, Lilan Wang, Guojian Liu, Haoxuan Zhu, Guanting Heng, Linyu Zhang, Fengli Li, Changwei Guo, Wenjie Zi, Li Qi
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,450
OpenAlex ID: W4417535514