Glycemic Gap vs Stress Hyperglycemic Ratio: A Comparative Assessment of Their Predictive Roles of Leptomeningeal Collateral Circulation and Clinical Outcomes in Acute Ischemic Large Vessel Occlusion.
Sai Kumar Reddy Pasya1, Emanuele Camerucci4, Chelsey Schartz3, Dina Alnuaimi5, Hussein Alsadi2, Prasanna Venkatesan Eswaradass6
1Department of neurology, 2Department of radiology, University of Kansas Medical Center, 3University of Kansas Medical Center, 4Department of neurology, Kansas University Medical Center, 5University of Jordan school of medicine, 6Department of neurology, University of Kansas Health System
Objective:
To investigate how glycemic gap (GG) and stress hyperglycemic ratio (SHR) correlate to leptomeningeal collateral circulation (LMC) and 90-day mRS in acute ischemic stroke (AIS) patients with a large vessel occlusion (LVO).
Background:
Stress hyperglycemia (SHG) has been associated with poor LMC, larger infarct volume, and worse stroke outcomes, especially in patients with LVO. There are multiple formulas to estimate SHG, and currently, the direct correlation between these formulas and collateral status is unknown.
Design/Methods:
In this retrospective single-center study, we chart-reviewed patients admitted with AIS, who had anterior circulation LVO. Admission glucose levels were used to calculate two glycemic ratios: the GG, defined as Admission Blood Glucose (mg/dL) − (28.7 × HbA1c − 46.7); and the SHR, calculated as Admission Blood Glucose / [(28.7 × HbA1c) − 46.7]. CTA collaterals were classified using the Regenhardt et al. Patients were categorized into three groups—malignant, intermediate, and symmetric—based on their CTA collateral scores. 90-day mRS was dichotomized into good (≤2) and poor (2-6). Univariable regression analyses were performed first, only significant variables were fitted into the final multivariable regression models.
Results:
A total of 267 patients with LVO ischemic stroke was included in the study, with 54.3% male and 45.7% female. Regression analysis revealed that higher SHR and GG values were correlating with worse CTA collateral scores (P <0.01). Higher SHG values were significantly associated with poor 90-days mRS (P <0.01, OR= 6.6 [1.8-24]), but GG had nonsignificant association (P <0.07, OR= 1.0 [0.9-1.1])
Conclusions:
There is a significant association between higher GG and SHR with poor LMC in patients with LVO. Nevertheless, SHG seems to have a stronger, and more significant association with 90-days mRS.
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