Effects of glycemic indicators on early neurological outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis

Table 1 Baseline characteristics of patients with acute ischemic stroke, mean ± standard deviation, n (%)

Characteristics	Admission hyperglycemia, n = 329	Without admission hyperglycemia, n = 490	P value
Age in years	68.47 ± 11.85	67.30 ± 11.84	0.165
Female	124 (37.7)	169 (34.5)	0.349
Coronary heart disease	53 (16.1)	70 (14.3)	0.474
Smoking	112 (34.0)	173 (35.3)	0.710
Drinking	84 (25.5)	127 (25.9)	0.901
Atrial fibrillation	59 (17.9)	78 (15.6)	0.449
History of TIA-S	77 (23.4)	104 (21.2)	0.461
Hypertension	218 (66.3)	288 (58.8)	0.031
Diabetes mellitus	149 (45.3)	129 (26.3)	< 0.001
Initial NIHSS, median (IQR)	9 (4, 14)	7 (4, 12)	< 0.001
Stroke subtype			0.076
Large artery atherosclerosis	116 (35.3)	157 (32.0)
Small artery disease	122 (37.1)	208 (42.4)
Cardioembolism	54 (16.4)	56 (11.4)
Others	37 (11.2)	69 (14.1)
Systolic blood pressure in mmHg	157.42 ± 23.65	156.59 ± 24.25	0.628
Diastolic blood pressure in mmHg	90.36 ± 15.03	90.94 ± 13.04	0.553
White blood cell counts as × 109	8.59 ± 3.04	8.26 ± 2.91	0.114
Platelets as × 109	208.49 ± 61.80	208.19 ± 59.92	0.945
Activated partial thromboplastin time in seconds	32.57 ± 7.95	32.85 ± 4.72	0.529
Prothrombin time in seconds	14.89 ± 17.33	14.27 ± 16.27	0.602
Total cholesterol in mmol/L	4.27 ± 1.62	4.16 ± 1.28	0.275
Triglyceride in mmol/L	1.71 ± 2.95	1.61 ± 3.43	0.669
Low-density lipoprotein in mmol/L	2.92 ± 1.01	2.80 ± 0.86	0.087
High-density lipoprotein in mmol/L	1.20 ± 0.44	1.22 ± 0.40	0.453
Door-to-needle treatment in minutes	33.14 ± 21.15	31.97 ± 20.46	0.430
Onset-to-treatment in minutes	146.83 ± 50.87	142.02 ± 49.12	0.176

IQR: Interquartile range; NIHSS: National Institutes of Health Stroke Scale; TIA-S: Transient ischemic attack and/or stroke.

Table 2 Demographics and clinical characteristics of the patients with acute ischemic stroke according to early neurological outcomes, mean ± standard deviation, n (%)

Characteristics	ENI group, n = 156	Neither ENI nor END group, n = 455	END group, n = 208	P value
Age in years	64.26 ± 11.28	67.94 ± 11.78	70.03 ± 11.88	< 0.001
Female	42 (26.9)	164 (36.0)	87 (41.8)	0.013
Coronary heart disease	23 (14.7)	64 (14.1)	36 (17.3)	0.552
Smoking	54 (34.6)	151 (33.2)	80 (38.5)	0.416
Drinking	43 (27.6)	110 (24.2)	58 (27.9)	0.508
Atrial fibrillation	43 (27.6)	61 (13.4)	33 (15.9)	< 0.001
History of TIA-S	29 (18.6)	104 (22.9)	48 (23.1)	0.501
Hypertension	85 (54.5)	276 (60.7)	145 (69.7)	0.010
Diabetes mellitus	51 (32.7)	150 (33.0)	77 (37.0)	0.554
Initial NIHSS, median (IQR)	6.5 (4, 11)	6 (3, 12)	10 (6, 16)	< 0.001
Stroke subtype				0.015
Large artery atherosclerosis	44 (28.2)	141 (31.0)	88 (42.3)
Small-artery disease	68 (43.6)	191 (42.0)	71 (34.1)
Cardioembolism	29 (18.6)	58 (12.7)	23 (11.1)
Others	15 (9.6)	65 (14.3)	26 (12.5)
Systolic blood pressure in mmHg	154.02 ± 25.15	156.39 ± 24.17	160.25 ± 22.44	0.038
Diastolic blood pressure in mmHg	91.17 ± 14.57	90.53 ± 13.73	90.75 ± 13.68	0.882
White blood cell counts as × 109	8.53 ± 2.95	8.30 ± 3.01	8.50 ± 2.88	0.528
Platelets as × 109	217.56 ± 67.24	205.75 ± 57.21	206.96 ± 62.37	0.103
Activated partial thromboplastin time in seconds	32.67 ± 4.17	32.93 ± 7.04	32.35 ± 5.57	0.525
Prothrombin time in seconds	13.44 ± 14.01	15.56 ± 19.17	13.03 ± 11.95	0.131
Total cholesterol in mmol/L	4.21 ± 1.19	4.18 ± 1.57	4.24 ± 1.24	0.863
Triglyceride in mmol/L	1.40 ± 0.84	1.71 ± 3.63	1.70 ± 3.45	0.577
Low-density lipoprotein in mmol/L	2.76 ± 0.90	2.85 ± 0.97	2.90 ± 0.84	0.326
High-density lipoprotein in mmol/L	1.19 ± 0.28	1.22 ± 0.49	1.19 ± 0.32	0.552
Door-to-needle treatment in minutes	29.46 ± 16.99	33.16 ± 21.84	33.10 ± 20.70	0.137
Onset-to-treatment in minutes	136.92 ± 45.03	144.71 ± 51.09	147.56 ± 50.26	0.117
Fasting blood glucose				< 0.001
First quartile: ≤ 5.09 mmol/L	51 (32.7)	119 (26.2)	33 (15.9)
Second quartile: 5.10-5.90 mmol/L	39 (25.0)	125 (27.5)	42 (20.2)
Third quartile: 5.91-7.66 mmol/L	37 (23.7)	111 (24.4)	57 (27.4)
Fourth quartile: > 7.67 mmol/L	29 (18.6)	100 (22.0)	76 (36.5)
Stress hyperglycemia ratio				< 0.001
First quartile: ≤ 0.85	37 (23.7)	137 (30.1)	29 (13.9)
Second quartile: 0.86-0.98	53 (34.0)	105 (23.1)	48 (23.1)
Third quartile: 0.99-1.16	35 (22.4)	116 (25.5)	54 (26.0)
Fourth quartile: > 1.16	31 (19.9)	97 (21.3)	77 (37.0)
Admission hyperglycemia	53 (34.0)	168 (36.9)	108 (51.9)	< 0.001

END: Early neurological deterioration; ENI: Early neurological improvement; IQR: Interquartile range; NIHSS: National Institutes of Health Stroke Scale; TIA-S: Transient ischemic attack and/or stroke.

Table 3 Multivariate analysis of the associations between glycemic indicators and early neurological outcomes in the whole population

Parameter	Early neurological deterioration			Early neurological improvement
	OR	95%CI	P value	OR	95%CI	P value
Admission hyperglycemia	1.744	1.236-2.463	0.002	0.928	0.622-1.383	0.712
Fasting blood glucose
First quartile	Reference	Reference	Reference	Reference	Reference	Reference
Second quartile	1.259	0.739-2.146	0.396	0.724	0.439-1.195	0.207
Third quartile	1.746	1.045-2.917	0.033	0.789	0.471-1.321	0.367
Fourth quartile	2.436	1.476-4.022	0.001	0.713	0.413-1.230	0.224
Stress hyperglycemia ratio
First quartile	Reference	Reference	Reference	Reference	Reference	Reference
Second quartile	2.306	1.342-3.960	0.002	1.875	0.976-2.321	0.067
Third quartile	2.284	1.346-3.876	0.002	1.059	0.618-1.816	0.834
Fourth quartile	3.486	2.088-5.820	0.001	1.293	0.736-2.274	0.372

Neither early neurological improvement nor early neurological deterioration group was the reference group. Adjustment by age, sex, blood pressure, atrial fibrillation, initial National Institutes of Health Stroke Scale, stroke subtype and systolic blood pressure. CI: Confidence interval; OR: Odds ratio.

Table 4 Multivariate logistical regression analyses depicting the association of glycemic indicators and early neurological outcomes in the patients with and without diabetes

Parameter	Early neurological deterioration			Early neurological improvement
	OR	95%CI	P value	OR	95%CI	P value
Patients with DM1
Admission hyperglycemia	1.954	1.061-3.601	0.032	0.723	0.356-1.468	0.369
Fasting blood glucose
First quartile	Reference	Reference	Reference	Reference	Reference	Reference
Second quartile	2.220	0.782-6.299	0.134	0.921	0.340-2.494	0.871
Third quartile	2.025	0.758-5.406	0.159	0.940	0.369-2.397	0.897
Fourth quartile	3.924	1.568-9.816	0.003	0.748	0.299-1.875	0.536
Fasting blood glucose
First quartile	Reference	Reference	Reference	Reference	Reference	Reference
Second quartile	3.620	1.743-7.734	0.002	1.932	0.973-6.910	0.063
Third quartile	2.826	1.143-6.990	0.025	1.203	0.470-3.078	0.699
Fourth quartile	5.744	2.410-9.831	0.001	1.536	0.567-4.162	0.398
Patients without DM2
Admission hyperglycemia	1.602	1.027-2.499	0.038	1.055	0.635-1.752	0.837
Fasting blood glucose
First quartile	Reference	Reference	Reference	Reference	Reference	Reference
Second quartile	1.035	0.551-1.944	0.914	0.671	0.373-1.207	0.183
Third quartile	1.646	0.894-3.033	0.110	0.746	0.399-1.393	0.357
Fourth quartile	1.873	0.984-3.565	0.056	0.739	0.359-1.520	0.411
Fasting blood glucose
First quartile	Reference	Reference	Reference	Reference	Reference	Reference
Second quartile	1.904	0.975-3.719	0.059	1.635	0.890-3.004	0.113
Third quartile	2.263	1.155-4.434	0.017	0.930	0.472-1.832	0.834
Fourth quartile	2.908	1.521-5.556	0.001	1.090	0.547-2.175	0.806

¹Adjustment by age, sex, atrial fibrillation, stroke subtype, initial National Institutes of Health Stroke Scale.

²Adjustment by age, atrial fibrillation, blood pressure, stroke subtype, initial National Institutes of Health Stroke Scale, systolic blood pressure, low-density lipoprotein.

Neither early neurological improvement nor early neurological deterioration group was the reference group. CI: Confidence interval; DM: Diabetes mellitus; OR: Odds ratio.