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Higher admission fasting plasma glucose levels are associated with a poorer short-term neurologic outcome in acute ischemic stroke patients with good collateral circulation

Acta Diabetologica Apr 18, 2018

Wang F, et al. - The purpose of this trial was to delineate the collateral circulation status of acute ischemic stroke patients by CT perfusion. Researchers also gauged the 90-day modified Rankin Scale (mRS) scores of patients with good or poor collaterals and its association with admission fasting plasma glucose (FPG). Eligible candidates included acute ischemic stroke patients who presented to the hospital 4.5 h within an onset of the first episode. Data shed light on the connection between higher admission FPG levels with markedly higher rates of unfavorable neurologic outcome of acute ischemic stroke patients with good collateral circulation. It was deduced that FPG and rFTD could present as beneficial predictors of short-term patient outcome. these could aid in the risk stratification for clinical decision making.

Methods

  • Between January 2009 and December 2015 acute ischemic stroke patients who presented to the hospital 4.5 h within an onset of the first episode were examined.
  • Using the 90-day mRS scores, neurological assessment was carried out (0-2 for a favorable and 3-6 for an unfavorable neurologic outcome).
  • Through CT perfusion scan, relative filling time delay (rFTD) was determined.
  • The primary outcomes included 90-day mRS scores stratified by good (rFTD ≤ 4 s) vs poor collateral circulation (rFTD > 4 s).

Results

  • Among 270 patients, 139 (51.5%) patients achieved a favorable neurologic outcome.
  • One hundred eighty-five (68.5%) patients presented with good collateral circulation.
  • A favorable neurologic outcome was obtained in considerably greater portions of patients with good collateral circulation (60.5%, 112/185) compared to those with poor collateral circulation (31.8%, 27/85) (P < 0.05).
  • It was noted that subjects with good collateral circulation achieving a favorable neurologic outcome presented with a markedly lower baseline FPG (6.6 ± 1.96) vs those with good collateral circulation achieving an unfavorable neurologic outcome (8.12 ± 4.02; P=0.002).
  • As per the Spearman correlation analysis, rFTD illustrated a prominent link with 90-day mRS scores (adjusted r = 0.258; P < 0.001) and admission FPG (r = 0.286; P < 0.001).

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