Objective:

To assess the association between the stress hyperglycemia ratio (SHR) and the occurrence of parenchymal hemorrhage (PH) following bridging thrombolysis and endovascular treatment (EVT) in patients with large vessel occlusion stroke (LVOS).

Background:

Thrombolysis in hyperglycemic LVOS patients is associated with an increased rate of intracranial hemorrhage and poor outcome. The stress hyperglycemia ratio (SHR), which accounts for both acute and baseline glycemic states, may better reflect the body's stress response compared to a single glucose measurement. 

Design/Methods:

SHR was defined as the ratio of admission glucose (mmol/l) to estimated average glucose derived from HbA1c (1.59 x HbA1c – 2.59). SHR values were dichotomized into < median and ≥ median for logistic regression analysis. Data were collected from 280 LVOS patients who received intravenous thrombolysis (IVT) and were referred for EVT between January 2020 and May 2024. Logistic regression was used to assess predictors of PH type 1 or 2 (composite endpoint variable).

Results:

Of the 280 LVOS patients, 99 patients received TPA and 181 received TNK. PH type 1 or 2 occurred in 12.9%. The median SHR was 1.04 (IQR 0.93 – 1.24) and did not differ between TPA and TNK cases (p=0.706). Univariable analysis showed that higher SHR, female sex, higher baseline NIHSS, lower platelet count, the number of thrombectomy passes, and stent-retriever use were associated with increased odds of developing PH type 1 or 2. Multivariable logistic regression revealed that both SHR (adjusted odds ratio [aOR] 2.762, 95% CI 1.244 – 6.131, p=0.013) and the number of thrombectomy passes were independent predictors of PH.

Conclusions:

A higher stress hyperglycemia ratio is independently associated with an increased risk of parenchymal hemorrhage in LVOS patients receiving bridging thrombolysis. These findings suggest that stress hyperglycemia may serve as a biomarker in predicting hemorrhagic complications in this patient population.