Impact of abnormal glucose metabolism on the early neurological outcome in acute ischemic stroke patients treated with intravenous thrombolysis

Abstract Background and purpose: Abnormal glucose metabolism status (AGM), including prediabetes and diabetes mellitus (DM) have been reported to be an important predictor of poor functional outcome in patients experiencing acute ischemic stroke (AIS). However, conclusions of recent studies are inconsistent about which AGM status increases the risk of post-thrombolysis early neurological deterioration (END). The purpose of this study was to evaluate the impact of AGM status on the risk of post-thrombolysis early neurological outcomes. We further investigated the influence of previous glucose control of diabetic patients on the post-thrombolysis early neurological outcomes evaluation. Methods: Prediabetes was identified as glycosylated hemoglobin (HbAlc) (%) level within the range of 5.7%-6.4%, and diabetes mellitus (DM) was diagnosed based on prior history of diabetes or an HbAlc≥6.5% and patients with HbAlc less than 5.7% were classified as normal glucose metabolism (NGM). Diabetic patients with good PGC had HbAlc <7%, diabetic patients with poor PGC had HbAlc≥7%. END was defined as a National Institutes of Health Stroke Scale Score (NIHSS) ≥ 4, ENI was defined as a ≥4-point decrease in NIHSS score or a complete resolution of neurological deficits, between the time of admission and 24 hours after IV-rtPA. Results In total, 261 (32.7%) patients were diagnosed with prediabetes, 91 (11.4%) patients were DM had good PGC and 186 (23.3%) patients were DM had poor PGC. After adjusted for confounders, in model 1, DM with poor PGC associated with the increased risk of post-thrombolysis END and poor functional outcome at discharge (OR, 2.09; 95% CI, 1.220-3.579; P=0.007) (OR, 1.91; 95% CI, 1.165-3.133; P=0.010), both prediabetes and DM with poor PGC were less likely to experience post-thrombolysis ENI (OR, 0.58; 95% CI, 0.377-0.907; P=0.016) (OR, 0.43; 95% CI, 0.255-0.71; P=0.001); in model 2, further adjusted for admission hyperglycemia, the presence of diabetes and DM with poor PGC was still independently related to post-thrombolysis ENI (OR, 0.62; 95% CI, 0.400-0.969; P=0.036) (OR, 0.51; 95% CI, 0.282-0.923; P=0.026). Conclusion Prediabetes and DM with poor PGC might be two abnormal blood glucose metabolism states that affects post-thrombolysis early neurological outcome in AIS patients.