Associations between stress hyperglycemia and outcomes in patients with ischemic stroke and TIA: the data comes from the Third China National Stroke Registry (CNSR-III).

In the acute stage of stroke, stress hyperglycemia is common in both diabetic and nondiabetic patients. The associations between stress hyperglycemia and functional outcomes, as well as stroke recurrence were heterogeneous in previous studies. We aimed to demonstrate these associations in a general population of patients with ischemic stroke and transient ischemic attack (TIA). We included patients with complete data on blood glucose and hemoglobin from The Third China National Stroke Registry. The stress hyperglycemia ratio (SHR) was calculated using fasting blood glucose (mmol/L) divided by glycosylated hemoglobin A1c (%). Outcomes included functional disability, recurrent ischemic stroke and TIA, combined vascular events, and all-cause mortality at 90 days. In total, 7186 patients were included (median age: 62 [54-70] years, male: 4864 [67.69%], TIA: 589 [8.20%]). SHR levels were significantly associated with functional disability (adjusted OR: 1.69, 95%CI: 1.22-2.33). For every 1 standard deviation increment in SHR, the risk of functional disability increased by 13%. Compared to the patients in SHR Tertile 1, those in Tertile 3 had a 1.31-fold increased risk of functional disability (95%CI: 1.08-1.60). There was a trend indicating that the risk of functional disability increased with higher SHR tertiles (P for trend = 0.0074). Stroke severity explained 42.94% of the total excess association between SHR and functional disability. However, neither SHR levels nor SHR tertiles were associated with recurrent ischemic stroke and TIA, combined vascular events, or all-cause mortality. This study found that admission stress hyperglycemia was associated with functional disability, which was partially mediated by stroke severity.