Stress Hyperglycemia Is Associated With Unfavorable Outcomes After Mechanical Thrombectomy in Patients With Acute Ischemic Stroke

Background Stress hyperglycemia may deteriorate stroke outcomes, but the effects of this condition on prognosis of mechanical thrombectomy remain undetermined. This study aimed to evaluate the impacts of stress hyperglycemia on in-hospital and 3-month outcomes of mechanical thrombectomy in stroke patients due to anterior circulation occlusion. Methods A total of 415 patients undergoing mechanical thrombectomy in the anterior circulation were enrolled. Stress hyperglycemia ratio (SHR) was measured with fasting glucose/glycated hemoglobin ratio and grouped as tertiles (i.e., SHR1–3) to compare in-hospital and 3-month outcomes using multivariable regression models. The effect of SHR stratified by diabetes status and the added value of SHR on the Totaled Health Risks in Vascular Events (THRIVE)-c risk score were also explored. Results The SHR3 group compared with the SHR1–2 group showed increased 24h symptomatic intracranial hemorrhage (adjusted odds ratio [aOR], 4.088; 95% confidence interval [CI], 1.551–10.772; P = 0.004), increased 72h early neurological deterioration (aOR, 3.505; 95% CI, 1.984–6.192; P < 0.001), and a similar incidence of post-stroke pneumonia (aOR, 1.379; 95% CI, 0.838–2.268; P = 0.206). At three months, patients in the SHR3 group had a worse distribution of modified Rankin scale (aOR, 2.261; 95% CI, 1.495–3.421; P < 0.001), and were at a higher risk of unfavorable functional outcome (adjusted hazard ratio [aHR], 1.629; 95% CI, 1.230–2.158; P = 0.001) and all-cause mortality (aHR, 1.986; 95% CI, 1.235–3.194; P = 0.005). The adverse effects of SHR were more often observed in non-diabetic patients, and including SHR significantly improved the accuracy of the THRIVE-c score for predicting poor stroke outcomes. Conclusions Stress hyperglycemia is related to the risks of in-hospital and 3-month poor outcomes after receiving mechanical thrombectomy in the anterior circulation.