Correlation Between Stress Hyperglycemia Ratio And In-hospital Prognosis In Patients Undergoing Intravenous Thrombolysis In Acute Ischemic Stroke

Objective:To investigate the correlation between the stress hyperglycemia ratio(SHR)and in-hospital adverse events and prognosis in patients undergoing intravenous thrombolysis in acute ischemic stroke,and to gain a deeper understanding of the mechanisms of stress hyperglycemia on brain tissue in acute ischemic stroke.The aim is to identify people at high risk of in-hospital comorbidity and in-hospital death and to prevent adverse events early.Methods:In this retrospective study,279 patients who presented to the first Bethune hospital of Jilin university with acute cerebral infarction and underwent intravenous thrombolysis between June 2021 and March 2023 was selected.The clinical case histories of the patients during their hospitalization were reviewed to collect basic information,general admission,past history,admission condition,information related to thrombolysis,routine laboratory tests before thrombolysis,fasting venous blood within 24 hours of admission,clinical diagnosis,and imaging data.The study endpoints were the occurrence of in-hospital adverse events,including death,cerebral infarction hemorrhagic transformation,cerebral infarction exacerbation(≥4-point increase in discharge NIHSS score from baseline),heart failure,acute coronary syndrome,severe infection,acute renal failure,and gastrointestinal bleeding.Patients were divided into low SHR and high SHR groups based on the median SHR of 279 patients.A statistical analysis was performed using IBM SPSS 25.0 statistical software to analyze whether there were differences in clinical data and in-hospital outcomes between the two groups.Odds ratios(OR)and 95% confidence intervals(CI)were calculated using binary logistic regression analysis.Subject operating characteristic(ROC)curves were analyzed using Medcalc software to compare the ROC curves of SHR with those of random blood glucose predicting intravenous thrombolysis in major adverse ischemic stroke,to find the best cut-off value and to investigate the predictive value of SHR in patients undergoing intravenous thrombolysis.Results:1.279 patients with intravenous thrombolysis in acute ischemic stroke were included in this study,including 196(70.3%)male patients with a mean age of63.44±11.38 years old.The large artery atherosclerosis type(LAA)accounted for the largest proportion of TOAST staging,with 177(63.4%)cases.Comorbidities were seen in 108(38.7%)of all patients.In terms of patient outcomes for cerebral infarction,there were 160(57.3%)patients with a significant improvement in symptoms with a 4 or more point reduction in discharge NIHSS score compared to admission NIHSS score versus a reduction in discharge NIHSS score to 0 or 1.There were 22(7.9%)patients with an increase in symptoms with a 4 or more point increase in discharge NIHSS score compared to admission,and 36(12.9%)patients with There were 36(12.9%)patients who had a hemorrhagic transformation,of which 9(3.2%)had a symptomatic hemorrhagic transformation(hemorrhagic transformation with a reduction in NIHSS score of 2 or more points).Deaths occurred in 10(3.6%)patients.2.Between the high and low SHR groups,more patients are in the low SHR group smoked,and more patients in the high SHR group demonstrated lower systolic blood pressure.The differences between the two groups were statistically significant(P<0.05)in fasting glucose,APTT,PT,PTR,INR,PTA,AST,and ALT;the differences between the two groups were not significant in TOAST typing,anterior and posterior circulation infarction,progressive stroke,cholesterol,LDL cholesterol,HDL cholesterol,triglycerides,albumin,albumin ratio,and creatinine.3.The discharge NIHSS score,the NIHSS score immediately after thrombolysis,and NIHSS score 24 hours after thrombolysis were all higher in the high SHR group than in the low SHR group,and the differences in NIHSS score 24 hours after thrombolysis,discharge NIHSS score and NIHSS minus between the two groups were significant(p<0.01),indicating that the effect of intravenous thrombolysis was more pronounced in the low SHR group than in the high SHR group.4.In terms of complications,the overall probability of HF and complications increased in the high SHR group compared to the low SHR group(p<0.05).There was no statistical difference in the probability of acute coronary syndrome,infection,liver impairment and renal impairment between the two groups.Regarding in-hospital outcomes of thrombolysis,the high SHR group had a higher proportion of significantly worse symptoms and a lower proportion of significantly improved symptoms than the low SHR group(p<0.017),and for the proportion of insignificant improvement,there was no statistical difference between the two groups.The high SHR group had a higher rate of conversion to bleeding,symptomatic conversion to bleeding,and mortality than the low SHR group(p<0.05).The overall number of days in hospitals was higher in the high SHR group than in the low SHR group(p<0.05).5.Correlation analysis between high and low SHR and in-hospital outcomes:(1)for the analysis of symptomatic bleeding conversion,SHR,platelet count,and LY%were independent influences on symptomatic bleeding conversion after including age,history of atrial fibrillation,LY%,Plt,triglycerides,and SHR indicators;(2)for the analysis of in-hospital mortality,age,admission NIHSS score,LY%,PLT count,albumin,cholesterol,and SHR indicators,SHR,age,albumin,LY%,and cholesterol remained as independent influencing factors for in-hospital death.6.The ROC curve of SHR for in-hospital death in patients undergoing intravenous thrombolysis in acute ischemic stroke showed a SHR-AUC of 0.842(95% CI 0.738-0.946,p<0.001),with a sensitivity of 80.0% and specificity of 74.3%,which is of value in predicting in-hospital death.Conclusions:1.Thrombolysis was more effective in the low-SHR group than in the high-SHR group,and the low-SHR group had a lower incidence of symptomatic post-thrombolytic hemorrhagic transformation and a lower probability of complications while in the hospital.In-hospital death after intravenous thrombolysis in acute ischemic stroke was more likely in the high SHR group than in the low SHR group.2.High SHR was an independent risk factor for symptomatic hemorrhagic transformation in patients undergoing intravenous thrombolysis in acute ischemic stroke;high SHR,high age,and high albumin were independent risk factors for in-hospital death in patients undergoing intravenous thrombolysis in acute ischemic stroke.3.The stress hyperglycemia ratio is a predictor of in-hospital mortality in patients undergoing intravenous thrombolysis in acute ischemic stroke,with an optimal cut-off value of 0.996.It can be used as a reference indicator to detect the level of glycemic control and to help identify high-risk patients early,as it is not influenced by a history of diabetes or chronic blood glucose levels.