Effects of glycemic indicators on early neurological outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis

Abstract Background: To investigate the predictive value of the glycemic indicators for early neurological outcomes (ENO) in patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT). Methods: The prospective collected database of AIS undergoing IVT at the Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University between January 2017 and Jun 2022 was retrospectively reviewed. ENO includes early neurological improvement (ENI) and early neurological deterioration (END), which was defined as a decrease or an increase in NIHSS score between baseline and 24 hours after IVT. The associations between glycemic indicators (including admission hyperglycemia [AH], fasting blood glucose [FBG] and Stress hyperglycemia ratio [SHR]) and ENO were analyzed in all patients and subgroups stratified by diabetes mellitus (DM). Results: A total of 819 patients with AIS treated with IVT were finally included. Of which, AH was found in 329 patients (40.2%). Compared with patients without AH, patients with AH were more likely to have a higher prevalence of DM (P﹤0.001) and hypertension (P=0.031), and presented with higher admission NIHSS score(P﹤0.001). During the first 24 h after IVT, END was observed in 208 patients (25.4%), and ENI was observed in 156 patients (19.0%). Compared to neither ENI nor END, END was independently associated with AH (OR=1.744, 95%CI: 1.236-2.463, P=0.002), FBG(OR=1.077, 95%CI: 1.017-1.141, P=0.012) and SHR(OR=1.600, 95%CI: 1.025-2.495, P=0.038). While none of the glycemic indicators was unrelated to the presence of ENI. Subgroup analysis indicated that AH (OR­ DM =1.954, 95%CI: 1.061-3.601, P=0.032; OR Non-DM =1.602, 95CI: 1.027-2.499, P=0.038), FBG (OR­ DM =1.105, 95%CI: 1.008-1.212, P=0.034; OR Non-DM =1.111, 95CI: 1.017-1.213, P=0.020), SHR(OR­ DM =3.126, 95%CI: 1.315-7.429, P=0.010; OR Non-DM =2.200, 95CI: 1.200-4.034, P=0.011) were all independently related to END both in patients with DM and those without DM. Nevertheless, none of the glycemic indicators was found associated with ENI in patients with DM and those without DM. Conclusions: Our study demonstrated that AH, FBG and SHR in stroke patients treated with IVT were associated with the presence of END rather ENI during the first 24 hours after admission.