Comparison of admission random glucose, fasting glucose, and glycated hemoglobin in predicting the neurological outcome of acute ischemic stroke: a retrospective study

Jia-Ying Sung; Chin-I Chen; Yi-Chen Hsieh; Yih-Ru Chen; Hsin-Chiao Wu; Lung Chan; Chaur-Jong Hu; Han-Hwa Hu; Hung-Yi Chiou; Nai-Fang Chi

doi:10.7717/peerj.2948

Comparison of admission random glucose, fasting glucose, and glycated hemoglobin in predicting the neurological outcome of acute ischemic stroke: a retrospective study

PeerJ. 2017 Feb 2:5:e2948. doi: 10.7717/peerj.2948. eCollection 2017.

Authors

Jia-Ying Sung¹, Chin-I Chen¹, Yi-Chen Hsieh², Yih-Ru Chen³, Hsin-Chiao Wu³, Lung Chan⁴, Chaur-Jong Hu⁴, Han-Hwa Hu⁴, Hung-Yi Chiou³, Nai-Fang Chi⁴

Affiliations

¹ Department of Neurology, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
² The PhD Program of Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University , Taipei , Taiwan.
³ School of Public Health, College of Public Health, Taipei Medical University , Taipei , Taiwan.
⁴ Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.

Abstract

Background: Hyperglycemia is a known predictor of negative outcomes in stroke. Several glycemic measures, including admission random glucose, fasting glucose, and glycated hemoglobin (HbA1c), have been associated with bad neurological outcomes in acute ischemic stroke, particularly in nondiabetic patients. However, the predictive power of these glycemic measures is yet to be investigated.

Methods: This retrospective study enrolled 484 patients with acute ischemic stroke from January 2009 to March 2013, and complete records of initial stroke severity, neurological outcomes at three months, and glycemic measures were evaluated. We examined the predictive power of admission random glucose, fasting glucose, and HbA1c for neurological outcomes in acute ischemic stroke. Furthermore, subgroup analyses of nondiabetic patients and patients with diabetes were performed separately.

Results: Receiver operating characteristic (ROC) analysis revealed that admission random glucose and fasting glucose were significant predictors of poor neurological outcomes, whereas HbA1c was not (areas under the ROC curve (AUCs): admission random glucose = 0.564, p = 0.026; fasting glucose = 0.598, p = 0.001; HbA1c = 0.510, p = 0.742). Subgroup analyses of nondiabetic patients and those with diabetes revealed that only fasting glucose predicts neurological outcomes in patients with diabetes, and the AUCs of these three glycemic measures did not differ between the two groups. A multivariate logistic regression analysis of the study patients indicated that only age, initial stroke severity, and fasting glucose were independent predictors of poor neurological outcomes, whereas admission random glucose and HbA1c were not (adjusted odds ratio: admission random glucose = 1.002, p = 0.228; fasting glucose = 1.005, p = 0.039; HbA1c = 1.160, p = 0.076). Furthermore, subgroup multivariate logistic regression analyses of nondiabetic patients and those with diabetes indicated that none of the three glycemic measures were associated with poor neurological outcomes.

Discussion: Fasting glucose is an independent predictor of poor neurological outcomes in patients with acute ischemic stroke and had greater predictive power than that of admission random glucose and HbA1c. The predictive power of glycemic measures for poor neurological outcomes did not differ significantly between the nondiabetic patients and those with diabetes.

Keywords: Acute ischemic stroke; Hyperglycemia; Neurological outcome.

Grants and funding

This work was supported by a grant from Taipei Medical University (98 TMU-SHH-04-03), Ministry of Science and Technology, Taiwan (104-2314-B-038-012-MY3, 104-2314-B-038-023-), Ministry of Health and Welfare (MOHW105-TDU-B-212-133018), and in part by The Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW105-TDU-B-212-133019), the China Medical University Hospital, the Academia Sinica Taiwan Biobank, the Stroke Biosignature Project (BM10501010037), and the NRPB Stroke Clinical Trial Consortium (MOST 104-2325- B-039 - 005-). All the funding or sources of support were received during the period of this study. There was no additional external funding received for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.