Association of prestroke glycemic status with stroke mortality.
Adult
Aged
Aged, 80 and over
Brain Ischemia
/ complications
Cerebral Hemorrhage
/ complications
Diabetes Complications
/ complications
Female
Glycated Hemoglobin
/ analysis
Humans
Italy
/ epidemiology
Male
Middle Aged
Prediabetic State
/ complications
Registries
Retrospective Studies
Risk Factors
Stroke
/ complications
Young Adult
adult diabetes
mortality
pre-diabetes
stroke
Journal
BMJ open diabetes research & care
ISSN: 2052-4897
Titre abrégé: BMJ Open Diabetes Res Care
Pays: England
ID NLM: 101641391
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
received:
05
10
2019
revised:
23
12
2019
accepted:
04
01
2020
entrez:
22
2
2020
pubmed:
23
2
2020
medline:
8
1
2021
Statut:
ppublish
Résumé
The role of diabetes as a predictor of mortality after stroke remains uncertain, and there are very few data for pre-diabetes. This study investigated the association of pre-diabetes and diabetes with 30-day and 1-year mortality after ischemic stroke (IS) and primary intracerebral hemorrhage (ICH). Between 2006 and 2013, 2076 patients with IS and 586 patients with ICH (median age 79) were admitted to hospital within 24 hours after stroke onset and were treated in a stroke unit, where they underwent measurement of glycated hemoglobin (HbA1c). Diabetes was retrospectively defined based on medical history, diagnosis during hospital stay or HbA1c ≥6.5% (48 mmol/mol). Pre-diabetes was defined as HbA1c of 5.7%-6.4% (39-47 mmol/mol). Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS). HRs were used to test the association of pre-diabetes and diabetes with 30-day and 1-year mortality after stroke onset. Among patients with IS, 830 had pre-diabetes and 632 had diabetes; 280 died within 30 days and the other 77 within 1 year. Among patients with ICH, 106 had pre-diabetes and 56 had diabetes; 150 died within 30 days and the other 92 within 1 year. In both stroke subtypes, pre-diabetes and diabetes were associated with higher 30-day mortality. In IS, however, the association was limited to patients with prestroke disability and very severe stroke. At NIHSS 25, HR was 1.58 (95% CI 1.07 to 2.35) for pre-diabetes and 1.67 (95% CI 1.14 to 2.46) for diabetes compared with normoglycemia. In ICH, the association was limited to women for pre-diabetes (HR 1.93, 95% CI 1.15 to 3.24) and to men for diabetes (HR 1.78, 95% CI 1.02 to 3.12). Prestroke glycemic status was unrelated to 1-year mortality. Both pre-diabetes and diabetes predict short-term mortality after acute stroke, but the association varies depending on both prestroke and stroke-related characteristics. These findings may explain the heterogeneous results obtained by previous studies.
Identifiants
pubmed: 32079614
pii: 8/1/e000957
doi: 10.1136/bmjdrc-2019-000957
pmc: PMC7039580
pii:
doi:
Substances chimiques
Glycated Hemoglobin A
0
hemoglobin A1c protein, human
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
MMWR Morb Mortal Wkly Rep. 2013 Mar 22;62(11):209-12
pubmed: 23515058
Cerebrovasc Dis. 2014;37(6):393-400
pubmed: 24993381
Eur J Neurol. 2018 Jun;25(6):825-832
pubmed: 29443444
Arch Intern Med. 2012 Nov 12;172(20):1548-56
pubmed: 23147454
Stroke. 2015 Jul;46(7):2032-60
pubmed: 26022637
Diabetes Care. 2009 Feb;32(2):348-54
pubmed: 19017775
J Diabetes Investig. 2019 May;10(3):780-792
pubmed: 30220102
Stroke. 1988 May;19(5):604-7
pubmed: 3363593
Sci Rep. 2016 Oct 31;6:36220
pubmed: 27796374
Stroke. 1993 Jan;24(1):35-41
pubmed: 7678184
Lancet Neurol. 2012 Mar;11(3):261-71
pubmed: 22341034
Stroke. 2016 Mar;47(3):682-8
pubmed: 26814235
J Stroke Cerebrovasc Dis. 2016 Jun;25(6):1431-43
pubmed: 27017281
Stroke. 2014 Jun;45(6):1881-6
pubmed: 24743441
Circulation. 2011 Feb 22;123(7):739-49
pubmed: 21300951
Cerebrovasc Dis. 2015;40(5-6):244-50
pubmed: 26484656
Neurology. 2003 Nov 25;61(10):1351-6
pubmed: 14638954
Neurology. 2016 Aug 30;87(9):870-8
pubmed: 27473136
J Neurol Neurosurg Psychiatry. 2013 Oct;84(10):1150-5
pubmed: 23715913
BMJ. 2016 Nov 23;355:i5953
pubmed: 27881363
Endocr Rev. 2016 Jun;37(3):278-316
pubmed: 27159875
Stroke. 2014 May;45(5):1498-500
pubmed: 24676777
J Stroke Cerebrovasc Dis. 2018 May;27(5):1127-1133
pubmed: 29605383
Lancet. 1974 Jul 13;2(7872):81-4
pubmed: 4136544
Stroke. 2015 Feb;46(2):361-8
pubmed: 25586833
Cerebrovasc Dis. 2013;36(4):290-1
pubmed: 24135489
Stroke. 2008 Oct;39(10):2727-31
pubmed: 18658031
Front Neurol. 2018 Apr 13;9:250
pubmed: 29706931
Cerebrovasc Dis. 2012;34(2):153-60
pubmed: 22907276
Arch Intern Med. 2004 Sep 13;164(16):1761-8
pubmed: 15364669
Stroke. 2017 Feb;48(2):513-519
pubmed: 28077454
J Clin Endocrinol Metab. 2010 Dec;95(12):5289-95
pubmed: 20861123
Cerebrovasc Dis. 2009;27 Suppl 1:148-55
pubmed: 19342845
J Neurol Neurosurg Psychiatry. 2014 Jun;85(6):660-7
pubmed: 24262916
Diabetes Care. 2018 Jan;41(Suppl 1):S13-S27
pubmed: 29222373
Nat Rev Neurol. 2018 Mar;14(3):168-181
pubmed: 29377010
BMJ Open Diabetes Res Care. 2017 Dec 16;5(1):e000451
pubmed: 29435349