Effect of Prestroke Glycemic Variability Estimated Glycated Albumin on Stroke Severity and Infarct Volume in Diabetic Patients Presenting With Acute Ischemic Stroke

Introduction: Whether glycemic variability prior to stroke increases the risk of stroke outcomes in prediabetic patients presenting with acute ischemic stroke is still unclear. We evaluated whether pre-stroke glycemic variability, estimated by glycated albumin (GA), increased early neurological deterioration (END) and functional outcomes in prediabetic patients with acute ischemic stroke. Methods: A total of 215 acute ischemic stroke patients with prediabetes were evaluated. The primary outcome was END, defined as an incremental increase in the National Institutes of Health Stroke Scale score by ≥1 point in motor power or ≥2 points in the total score within the 7 days after admission. The secondary outcome was poor functional status defined by a modified Rankin Scale at 3 months. Higher GA (≥16.0%) was determined to reflect glycemic fluctuation prior to ischemic stroke. Results: Of the 215 prediabetic patients, 77 (35.8%) were in the higher GA group. In prediabetic patients, END occurrence and poor functional status were higher in the higher GA group than in the lower GA group. The multivariate analysis showed that a higher GA was associated with an increased risk of END occurrence and poor functional outcomes at 3 months (adjusted odds ratio [95% confidence interval], 4.58 [1.64–12.81], p = 0.004 and 2.50 [1.19–5.25], p = 0.02, respectively). Conclusion: Pre-stroke glycemic variability estimated by GA was associated with END occurrence and poor functional outcome after ischemic stroke in patients with prediabetes.

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Serum YKL-40 Levels Correlate with Infarct Volume, Stroke Severity, and Functional Outcome in Acute Ischemic Stroke Patients

PLoS ONE ◽

10.1371/journal.pone.0051722 ◽

2012 ◽

Vol 7 (12) ◽

pp. e51722 ◽

Cited By ~ 14

Author(s):

Hyun Young Park ◽

Chang-Duk Jun ◽

Se-Jeong Jeon ◽

See-Sung Choi ◽

Hak-Ryul Kim ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Infarct Volume ◽

Stroke Severity ◽

Stroke Patients

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Abstract TP429: Early Oral Anticoagulation After Acute Ischemic Stroke in Patients With Atrial Fibrillation

Stroke ◽

10.1161/str.47.suppl_1.tp429 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Andrew B Buletko ◽

Rejo P Cherian ◽

Christine Ahrens ◽

Ken Uchino ◽

Andrew Russman

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Oral Anticoagulation ◽

Infarct Volume ◽

Cleveland Clinic ◽

Early Initiation ◽

Stroke Severity ◽

Major Hemorrhage

Introduction: Uncertainty exists as to the optimum interval for initiation of oral anticoagulation (OAC) after an acute ischemic stroke (AIS) in patients with atrial fibrillation (AF). Randomized clinical trials of novel oral anticoagulants excluded patients with AIS within 7-14 days. We sought to identify patients at low risk for early initiation of OAC after AIS. Hypothesis: The benefit of starting OAC within 2 days to prevent recurrent AIS outweighs the risk of hemorrhagic transformation (HT) in select patients. Methods: Following IRB approval, we completed a retrospective review of patients from the Cleveland Clinic from 2012-2014 with AIS, AF, and at least 1 follow up visit. In addition to demographic and medical history, acute infarct volume on imaging, presence of HT on imaging prior to OAC, timing and type of oral anticoagulation, and ischemic and hemorrhagic complications were noted. Early OAC was defined as starting within 48 hours after stroke onset, and late OAC was thereafter. The two groups were compared using Fisher’s exact test for categorical and Wilcoxon Rank Sum for numeric variables. Results: One hundred patients (median age 76, interquartile range 66-84) met our study criteria. Thirty-one patients were started on OAC within 2 days vs 53 patients after 2 days (median 1 days vs median 11 days). Compared to patients started on OAC after 2 days, those who initiated OAC within 2 days had significantly lower infarct volume (median 3.35 ml vs median 9.8 ml; p<0.0001), initial NIHSS (median 3 vs median 7; p <0.0001), and fewer people with blood on brain imaging (3% vs 26%; p= 0.0074). Age, prior stroke, and choice of OAC were not significantly associated with timing of OAC. No patients had recurrent AIS or symptomatic HT at median follow-up observation of 37 days. One patient had a non-CNS major hemorrhage after starting OAC. Sixteen patients were not started on OAC for a variety of reasons. Conclusions: Our results suggest the safety of early initiation of OAC with 2 days in an appropriately selected population of patients with AIS, who have small infarct volumes, mild stroke severity, and lack of HT.

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Neurobiochemical Markers of Brain Damage in Cerebrospinal Fluid of Acute Ischemic Stroke Patients

Clinical Chemistry ◽

10.1373/clinchem.2009.134122 ◽

2010 ◽

Vol 56 (3) ◽

pp. 451-458 ◽

Cited By ~ 53

Author(s):

Raf Brouns ◽

Bart De Vil ◽

Patrick Cras ◽

Didier De Surgeloose ◽

Peter Mariën ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Calcium Binding ◽

Infarct Volume ◽

Neuron Specific Enolase ◽

Stroke Severity ◽

Stroke Outcome ◽

Stroke Patients ◽

Nihss Score

Abstract Background: Ischemic injury to the central nervous system causes cellular activation and disintegration, leading to release of cell-type–specific proteins into the cerebrospinal fluid (CSF). We investigated CSF concentrations of myelin basic protein (MBP), glial fibrillary astrocytic protein (GFAP), the calcium-binding protein S100B, and neuron-specific enolase (NSE) in acute ischemic stroke patients and their relation to initial stroke severity, stroke location, and long-term stroke outcome. Methods: CSF concentrations of MBP, GFAP, S100B, and NSE were assessed in 89 stroke patients on admission (mean 8.7 h after stroke onset) and in 35 controls. We evaluated the relation between CSF concentrations and (a) stroke severity (NIH Stroke Scale [NIHSS] score on admission, infarct volume), (b) stroke location, and (c) stroke outcome (modified Rankin Scale [mRS] score at month 3). Results: MBP concentration was significantly higher in subcortical than in cortical infarcts (median MBP, 1.18 vs 0.66 μg/L, P < 0.001). GFAP and S100B concentrations correlated with the NIHSS score on admission (GFAP, R = 0.35, P = 0.001; S100B, R = 0.29, P = 0.006), infarct volume (GFAP, R = 0.34, P = 0.001; S100B, R = 0.28, P = 0.008), and mRS score at month 3 (R = 0.42, P < 0.001 and R = 0.28, P = 0.007). Concentrations of NSE did not correlate with stroke characteristics. Conclusions: MBP, GFAP, S100B, and NSE display relevant differences in cellular and subcellular origins, which are reflected in their relation to stroke characteristics. MBP is a marker for infarct location. GFAP and S100B correlate with stroke severity and outcome.

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Targets of vascular protection in acute ischemic stroke differ in type 2 diabetes

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00720.2012 ◽

2013 ◽

Vol 304 (6) ◽

pp. H806-H815 ◽

Cited By ~ 35

Author(s):

Aisha I. Kelly-Cobbs ◽

Roshini Prakash ◽

Weiguo Li ◽

Bindu Pillai ◽

Sherif Hafez ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Infarct Volume ◽

Hemorrhagic Transformation ◽

Artery Occlusion ◽

Neurological Deficits ◽

Diabetic Patients ◽

Vascular Protection ◽

Acute Therapy

Hemorrhagic transformation is an important complication of acute ischemic stroke, particularly in diabetic patients receiving thrombolytic treatment with tissue plasminogen activator, the only approved drug for the treatment of acute ischemic stroke. The objective of the present study was to determine the effects of acute manipulation of potential targets for vascular protection [i.e., NF-κB, peroxynitrite, and matrix metalloproteinases (MMPs)] on vascular injury and functional outcome in a diabetic model of cerebral ischemia. Ischemia was induced by middle cerebral artery occlusion in control and type 2 diabetic Goto-Kakizaki rats. Treatment groups received a single dose of the peroxynitrite decomposition catalyst 5,10,15,20-tetrakis(4-sulfonatophenyl)prophyrinato iron (III), the nonspecific NF-κB inhibitor curcumin, or the broad-spectrum MMP inhibitor minocycline at reperfusion. Poststroke infarct volume, edema, hemorrhage, neurological deficits, and MMP-9 activity were evaluated. All acute treatments reduced MMP-9 and hemorrhagic transformation in diabetic groups. In addition, acute curcumin and minocycline therapy reduced edema in these animals. Improved neurological function was observed in varying degrees with treatment, as indicated by beam-walk performance, modified Bederson scores, and grip strength; however, infarct size was similar to untreated diabetic animals. In control animals, all treatments reduced MMP-9 activity, yet bleeding was not improved. Neuroprotection was only conferred by curcumin and minocycline. Uncovering the underlying mechanisms contributing to the success of acute therapy in diabetes will advance tailored stroke therapies.

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Factor VIIa and tissue factor procoagulant activity in diabetes mellitus after acute ischemic stroke: Impact of hyperglycemia

Thrombosis and Haemostasis ◽

10.1160/th06-12-0719 ◽

2007 ◽

Vol 98 (11) ◽

pp. 1007-1013 ◽

Cited By ~ 24

Author(s):

Vijender Vaidyula ◽

Uday Kanamalla ◽

Michael De Angelis ◽

John Gaughan ◽

Nina Gentile ◽

...

Keyword(s):

Diabetes Mellitus ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Tissue Factor ◽

Factor Viia ◽

Procoagulant Activity ◽

Diabetic Patients ◽

Stroke Severity ◽

Plasma Factor

SummaryAlterations in blood coagulation may explain the poorer neurological outcome with diabetes mellitus and hyperglycemia after acute ischemic stroke. We studied the relationships between diabetes mellitus, hyperglycemia, whole blood tissue factor procoagulant activity (TF-PCA) and plasma Factor VIIa (FVIIa) in ten patients with type 2 diabetes mellitus and 11 non-diabetic patients at baseline and 6, 12, 24, and 48 hours (h) after presentation for acute stroke. In addition, we examined plasma prothrombin fragment 1+2 (F1.2) and thrombin-antithrombin complexes (TAT) as markers of thrombin generation. Stroke severity, assessed by National Institute of Health Stroke Scale (NIHSS), was similar at baseline (p=0.26) but worse in diabetic (8.20 ± 4.3) than nondiabetic patients (2.67 ± 2.1,p=0.023) at 48 h. At presentation, diabetic patients had higher FVIIa (p=0.004) and lower TF-PCA (p=0.027) than non-diabetic patients but both were higher than in normal control subjects. FVIIa levels remained higher in diabetic patients at 6, 12 and 24 h after stroke. In diabetic patients, FVIIa (r=0.40, p=0.02) and TF-PCA (r=0.50, p=0.02) correlated with blood glucose; and, FVIIa correlated with plasma F1.2 (r=0.34, p=0.002) and TAT levels (r=0.62, p<0.0001). In non-diabetic patients, TF-PCA, but not FVIIa, correlated with F1.2 (r=0.402, p=0.010) andTAT (r=0.39, p=0.011). Combining both groups, NIHSS scores were positively related to FVIIa levels (r=0.50,p=0.021) and inversely related toTF-PCA levels (r=-0.498, p=0.02). Acute ischemic stroke patients with diabetes and hyperglycemia have a more intense procoagulant state compared with nondiabetic patients. This is related to glucose levels and provides a potential mechanism for the observed worse prognosis in such patients after acute stroke.

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The initial glycemic variability is associated with early neurological deterioration in diabetic patients with acute ischemic stroke

Neurological Sciences ◽

10.1007/s10072-018-3463-6 ◽

2018 ◽

Vol 39 (9) ◽

pp. 1571-1577 ◽

Cited By ~ 7

Author(s):

Jiaojie Hui ◽

Jianping Zhang ◽

Xuqiang Mao ◽

Zaiwang Li ◽

Xinxin Li ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Glycemic Variability ◽

Neurological Deterioration ◽

Diabetic Patients ◽

Early Neurological Deterioration

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Range of glucose as a glycemic variability and 3–month outcome in diabetic patients with acute ischemic stroke

PLoS ONE ◽

10.1371/journal.pone.0183894 ◽

2017 ◽

Vol 12 (9) ◽

pp. e0183894 ◽

Cited By ~ 6

Author(s):

Young Seo Kim ◽

Chulho Kim ◽

Keun-Hwa Jung ◽

Hyung-Min Kwon ◽

Sung Hyuk Heo ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Glycemic Variability ◽

Diabetic Patients

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High glycemic albumin representing prestroke glycemic variability is associated with hemorrhagic transformation in patients receiving intravenous thrombolysis

Scientific Reports ◽

10.1038/s41598-021-04716-4 ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Sang-Hwa Lee ◽

Min Uk Jang ◽

Yerim Kim ◽

So Young Park ◽

Chulho Kim ◽

...

Keyword(s):

Regression Analysis ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Characteristic Curve ◽

Glycated Albumin ◽

Intravenous Thrombolysis ◽

Predictive Ability ◽

Glycemic Variability ◽

Hemorrhagic Transformation ◽

The Impact

AbstractWe evaluated the impact of prestroke glycemic variability estimated by glycated albumin (GA) on symptomatic hemorrhagic transformation (SHT) in patients with intravenous thrombolysis (IVT). Using a multicenter database, we consecutively enrolled acute ischemic stroke patients receiving IVT. A total of 378 patients were included in this study. Higher GA was defined as GA ≥ 16.0%. The primary outcome measure was SHT. Multivariate regression analysis and a receiver operating characteristic curve were used to assess risks and predictive ability for SHT. Among the 378 patients who were enrolled in this study, 27 patients (7.1%) had SHT as defined by the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SHTSITS). The rate of SHTSITS was higher in the higher GA group than in the lower GA group (18.0% vs. 1.6%, p < 0.001). A higher GA level (GA ≥ 16.0%) significantly increased the risk of SHTSITS (adjusted odds ratio [OR], [95% confidence interval, CI], 12.57 [3.08–41.54]) in the logistic regression analysis. The predictive ability of the GA level for SHTSITS was good (AUC [95% CI]: 0.83 [0.77–0.90], p < 0.001), and the cutoff value of GA in SHT was 16.3%. GA was a reliable predictor of SHT after IVT in acute ischemic stroke in this study.

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