Postoperative Blood Glucose Trajectories and Inflammatory Markers: Prognostic Implications in Acute Ischemic Stroke Treated by Thrombectomy

Hyperglycemia frequently occurs after acute ischemic stroke and is associated with worse neurological outcomes. However, the impact of postoperative blood glucose trends, especially in patients with large vessel occlusion (LVO) stroke undergoing mechanical thrombectomy (MT), remains unclear. In this retrospective cohort study of 150 patients with LVO stroke treated with MT between March 2023 and September 2024, we assessed the association between postoperative blood glucose trajectories and 90-day functional outcomes, as well as the potential inflammatory response underlying this association. Daily fingerstick capillary blood glucose levels (fasting and postprandial) were measured for the first seven days post-procedure, and linear regression was used to calculate the slope of the postoperative glucose trend for each patient. Patients were divided into Glucose-Increasing (n = 75) and Glucose-Decreasing (n = 75) groups based on the median slope. The primary outcome was 90-day functional status, assessed by the modified Rankin Scale (mRS) through outpatient clinic visits or structured telephone interviews; secondary outcomes included postoperative day 1 levels of C-reactive protein (CRP), interleukin-6 (IL-6), and interleukin-10 (IL-10). Patients in the Glucose-Increasing Group had significantly higher median 90-day mRS scores (4.0 vs. 3.0; P = 0.030) and higher postoperative CRP (5.2 vs. 4.1 mg/L; P = 0.022), IL-6 (6.9 vs. 5.7 pg/mL; P = 0.015), and IL-10 (134 vs. 104 pg/mL; P = 0.0017) levels. Multivariate logistic regression adjusting for potential confounders did not identify glucose trend group as an independent predictor of poor outcome (mRS ≥ 3; odds ratio 0.67, 95% CI 0.34–1.37; P = 0.272). These findings suggest that an increasing postoperative blood glucose trend is associated with higher inflammatory markers and poorer functional outcomes in LVO stroke patients undergoing thrombectomy, although it may not be an independent predictor when adjusted for other factors, underscoring the need for future prospective studies.