Study On The Association Between Abnormal Glucose Metabolism And Prognosis In Patients With Acute Ischemic Stroke

Objective：1.To study the association between abnormal glucose regulation (AGR) and therecovery of neurological function in patients with acute ischemic stroke (AIS).2.To explore the relationship between abnormal glucose regulation (AGR) andstroke recurrence and cardiovascular events in patients after acute ischemic stroke(AIS), and to validate the predictive value of the Essen Stroke Risk Score (ESRS) in ahospital-based follow-up study and tried to modify it.Methods：1.Consecutive patients diagnosed with acute ischemic stroke who were admittedto the First Affiliated Hospital of Henan University of Science and Technologybetween October2011and August2013. Demographic characteristics, risk factors,interventions and the score of ESRS were recorded.2.Abnormal glucose metabolism including diabetes and impaired glucoseregulation (IGR), the latter includes isolated impaired fasting glucose (I-IFG)、isolated impaired glucose tolerance (I-IGT) and combined impaired fasting glucoseand impaired glucose tolerance (IFG+IGT). After14±3days of the patients onsets, anoral glucose tolerance text (OGTT) would be preformed in patients without diabetes.According to the OGTT results, all patients were divided into three groups: diabetesmellitus (DM, including previously diagnosed DM and newly diagnosed DM), IGRand normal glucose tolerance (NGT) groups.3.At3and12months after stroke onset, the outcomes of all patients wereassessed through telephone or outpatient follow-up, including death (or modifiedRankin Scale [mRS] score=6), dependency (defined by mRS=3to5), recurrence ofstroke, cardiovascular vascular events (including myocardial infarction, angina, and soon), and the corresponding dates of onset. Poor outcomes were defined as death or dependency (mRS=3to6).4.Comparison of demographic and clinical characteristics in stroke patients indifferent groups by the X2test and one-way ANOVA for categorical and continuousvariables, respectively.5.The associations between DM and3-month outcome (3months mRS3to6)were analyzed by a logistic regression analysis, multivariate-adjusted odds ratios (OR)including other confounding factors such as age, sex, hypertension, coronary heartdisease, atrial fibrillation, smoking, alcohol, history of stroke and family history ofstroke.6.At1year after stroke onset, the vascular events of all patients were assessed,including death, recurrence of stroke, cardiovascular vascular events. According to theoutcomes, the AIS patients were divided into two groups, recurrence group andwithout recurrence group. The two groups were compared in regard to demographicand clinical characteristics using the X2test for categorical variables and a t-test forparametric analysis.7.Association between the glycemic status and recurrence of stroke orcardiovascular vascular events through age and sex adjusted odds ratios (OR) by alogistic regression analysis.8.The area under receiver operating characteristic (ROC) curve of the ESRS andmodified ESRS predicting the recurrence rate of stroke or cardiovascular vascularevents.Results：1.Of the691subjects analyzed, OGTT was refused in35patients,19were lost tofollow-up. Follow-up information was available for637patients at3months and407patients at1year after stroke onset.2.Among637inpatients with AIS, the prevalence of AGR of75.8%, of whom166(26.1%) had a history of DM, and127(19.9%) were newly diagnosed by OGTT. Theprevalence of IGR was29.8%. The prevalence of IFG, IGT and IFG+IGT were2.2%,21.7%and6.0%respectively.3.According to the OGTT results,637inpatients with AIS were divided into threegroups, NGT, IGR and DM groups. The prevalence of DM among patients aged≥60years was higher than those aged＜60years (P＜0.05). The prevalence of DM wassignificantly higher in patients with hypertension and in female patients (P＜0.05). However, the constituent ratio of smoking declined. There was no association betweencoronary heart disease and abnormal glucose regulation (AGR), similar associationswere observed among atrial fibrillation, alcohol, history of stroke or family history ofstroke and AGR (P＞0.05).4.Three months after stroke onset, the occurrence of death or dependency wassignificantly higher in patients with DM and IGR (P＜0.05). Risk of poor outcome (3months mRS≥3) was significantly higher in DM group (OR:1.919,95%CI:1.270to2.899) than that in NGT group, even after adjusting for confounding factors (OR:1.835,95%CI:1.188to2.834). However, IGR was not associated with a poor prognosis afteracute ischemic stroke (OR:1.485,95%CI:0.947to2.328).5.A total of355non-cardiac acute ischemic stroke were admitted. The cumulativerate of recurrent stroke and cardiovascular disease was19.2%(68/355). The risk ofcombined vascular events was significantly higher in female patients than that in malepatients (P＜0.05). Risk of combined vascular events were significantly higher in theDM group compared with the NGT group even after adjusting for age and sex(OR:1.763,95%CI:1.840to3.702). However, we haven’t found that between IGR andNGT groups (OR:1.119,95%CI:0.489to2.562).6.The risk of combined vascular events was significantly higher in patients withESRS≥3than patients with ESRS≤2(P＜0.05). The modified ESRS was calculatedfrom scores for gender and impaired glucose tolerance in addition to that in ESRS. Thearea under the curve (AUC) was0.630(95%CI:0.555-0.706) for modified ESRS and0.617(95%CI:0.540-0.694) for ESRS, there was no significant (P＞0.05).Conclusion:1.Diabetes mellitus was an independent risk factor for poor outcome andcombined vascular events in patients with acute ischemic stroke after onset.2.There was no association between pre-diabetes and short-term prognosis (3months mRS≥3) or vascular events within1year after acute ischemic stroke onset.