Stress hyperglycemia ratio and hypoperfusion volume predict early neurological deterioration in patients with minor stroke due to large vessel occlusion in anterior circulation
10.3760/cma.j.issn.1673-4165.2024.11.003
- VernacularTitle:应激性高血糖比值和低灌注体积预测前循环大血管闭塞性轻型卒中患者早期神经功能恶化
- Author:
Lidan CAO
1
;
Ming LIU
;
Zhenduo LI
;
Kechun CHEN
Author Information
1. 苏州大学附属张家港医院（张家港市第一人民医院）神经内科，苏州 215600
- Keywords:
Ischemic stroke;
Severity of illness index;
Disease progression;
Blood glucose;
Glycated hemoglobin;
Perfusion imaging;
Tomography, X-ray computed;
Risk fact
- From:
International Journal of Cerebrovascular Diseases
2024;32(11):814-820
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the predictive value of stress hyperglycemic ratio (SHR) and hypoperfusion volume for early neurological deterioration (END) in patients with minor stroke due to large vessel occlusion in anterior circulation.Methods:Consecutive patients with minor stroke due to large vessel occlusion in anterior circulation admitted to the Department of Neurology, Zhangjiagang Hospital Affiliated to Soochow University from October 2021 to January 2024 were included retrospectively. Minor stroke was defined as a baseline National Institutes of Health Stroke Scale (NIHSS) score of ≤ 5. SHR was calculated as the fasting blood glucose to glycated hemoglobin ratio, and CT perfusion imaging Tmax >6 s volume represented severe hypoperfusion volume. END was defined as an increase of ≥4 in NIHSS score compared to the baseline within 24 hours of onset. Multivariate logistic regression analysis was used to determine the independent risk factors for END. Receiver operating characteristic (ROC) curves was used to determine the predictive value of each independent predictor for END. Results:A total of 190 patients were enrolled, including 52 females (27.4%), aged 65.89±14.30 years. The baseline NIHSS score was 3 (interquartile range, 2-5). Forty-six patients (24.2%) experienced END, and 22 received salvage endovascular treatment. Univariate analysis showed that there were significant differences in severe hypoperfusion volume, SHR, and the proportion of patients with fasting blood glucose >7 mmol/L between the END group and the non-END group (all P<0.05). Multivariate logistic regression analysis showed that SHR (odds ratio [ OR] 7.736, 95% confidence interval [ CI] 1.082-55.286; P=0.041) and Tmax >6 s volume ( OR 1.006, 95% CI 1.001-1.010; P=0.009) were the independent predictive factors for END. ROC curve analysis showed that area under the curve of SHR and Tmax >6 s volume for predicting END were 0.720 (95% CI 0.632-0.807) and 0.649 (95% CI 0.561-0.737), respectively. The optimal cutoff value for SHR was 1.03, and the sensitivity and specificity were 60.9% and 79.9%, respectively; the optimal cutoff value for Tmax >6 s volume was 38.7 ml, and the sensitivity and specificity were 89.1% and 39.6%, respectively. The area under the curve of combining the two indicators to predict END was 0.736 (95% CI 0.654-0.848). Conclusion:In patients with minor stroke due to large vessel occlusion in anterior circulation, higher SHR and larger severe hypoperfusion volume have certain predictive value for END.
