The Stress Hyperglycemia Ratio is Associated with Hemorrhagic Transformation in Patients with Acute Ischemic Stroke

Abstract

Background

Hemorrhagic transformation (HT) is a severe complication occurring in acute ischemic stroke (AIS) patients. Stress hyperglycemia is frequent in patients with acute illness such as stroke. We aimed to explore the association between stress hyperglycemia and HT in AIS patients.

Methods

A total of 287 consecutive participants with HT and 285 age- and sex-matched stroke patients without HT were enrolled in this study. Baseline glucose and glycated hemoglobin (HbA1c) levels were collected to measure stress hyperglycemia. The stress hyperglycemia ratio (SHR) was calculated by dividing the fasting plasma glucose at admission with HbA1c. HT was diagnosed by follow-up imaging assessment, and was radiologically classified as hemorrhagic infarction type (HI) 1 or 2 or parenchymal hematoma type (PH) 1 or 2.

Results

Univariate analysis showed that SHR is significantly higher among patients with HT than those without HT. Compared to the patients in the lower three quartiles of SHR, the incidence of HT was significantly higher among patients with the highest quartile of SHR in total population, diabetic and non-diabetic population. We also observed that patients with the highest SHR quartile were associated with an increased risk of hemorrhagic transformation after adjusted for potential covariates (68.4% versus 39.1%; adjusted odds ratio, 2.320; 95% confidence interval, 1.207–4.459; P=0.012).

Conclusion

The stress hyperglycemia ratio, representing the state of stress hyperglycemia, was significantly associated with an increased risk of hemorrhagic transformation in patients with acute ischemic stroke.

Keywords:

• hyperglycemia
• hemorrhagic transformation
• acute ischemic stroke
• stress hyperglycemia

Acknowledgments

We thank all staff members and participants involved in the study. Cheng-Xiang Yuan and Si-Yan Chen are co-first authors.

Abbreviations

AIS, acute ischemic stroke; HbA1c, glycated hemoglobin; HT, hemorrhagic transformation; HI, hemorrhagic infarct; PH, parenchymal hematoma; SHR, stress hyperglycemia ratio.

Data Sharing Statement

Research data are not shared.

Ethics Statement

This study was approved by the Medical Ethics Committee of the First Affiliated Hospital of Wenzhou Medical University. Given the retrospective nature of this study, there was no requirement for informed consent. The study protocol conforms to the ethical guidelines of the Declaration of Helsinki. The data was maintained with confidentiality and not shared.

Disclosure

The authors declare that they have no conflict of interest.