Zhongguo quanke yixue (May 2024)
Nested Case-control Study on the Impact of Stress Hyperglycemia Ratio on the Recurrence of Mild Acute Ischemic Stroke in the Elderly
Abstract
Background In the context of aging in our country, the incidence and recurrence rates of acute ischemic stroke (AIS) are increasing year by year, and the mortality and disability rates are high. In recent years, the application of stress hyperglycemia ratio (SHR) in cardiovascular and cerebrovascular diseases has become more and more common, but its research in the recurrence of mild AIS is currently limited. Objective To explore the correlation between SHR and the recurrence of mild AIS in elderly patients within one year, and to provide a more theoretical basis for the prevention of AIS recurrence. Methods The study selected patients who were first diagnosed with mild AIS at the Shijiazhuang Fifth Hospital from May 2018 to January 2022. The study started with the diagnosis of mild AIS and ended one year after the diagnosis. A nested case-control study was conducted, and patients who were confirmed to have a recurrence within one year were included in the recurrence group. The non-recurrence group was matched at a ratio of 1∶3 based on 'diagnosis time, age, gender, infarction location, and whether they have diabetes'. A total of 70 patients were included in the recurrence group, and 210 patients were matched in the non-recurrence group. Through the Hospital Information System (HIS), patients gender, age, history of hypertension, history of atrial fibrillation, BMI, baseline NIHSS score, LDL-C, HbA1c, random blood glucose on admission, etc. were collected, and the SHR was calculated. Multivariate conditional Logistic regression analysis was used to explore the correlation between SHR and the 1-year recurrence of mild AIS in elderly patients. This study is likely investigating the influence of the SHR on the recurrence of AIS within one year in elderly patients. Results The average age of the 280 patients was (71.9±6.4) years; 176 were male (62.9%), and 104 were female (37.1%) ; 88 patients (31.4%) had a history of diabetes. According to the median of the data, stress hyperglycemia ≥10 mmol/L was considered high, <10 mmol/L was considered low; SHR>1.04 was considered high, ≤1.04 was considered low. Multivariate conditional Logistic regression analysis showed that stress hyperglycemia (OR=2.983, 95%CI=1.488-5.977), SHR (OR=3.056, 95%CI=1.579-5.914) were factors affecting the 1-year recurrence of mild AIS in elderly patients (P<0.05). Among the 88 patients with a history of diabetes and mild AIS, 22 had a recurrence within 1 year, and 66 did not; among the 192 patients without a history of diabetes and mild AIS, 48 had a recurrence within 1 year, and 144 did not. The results of multivariate conditional Logistic regression analysis in the stratified analysis showed that SHR was still a factor affecting the 1-year recurrence of mild AIS in elderly patients with (OR=3.757, 95%CI=1.019-13.845) and without (OR=3.129, 95%CI=1.162-8.427) a history of diabetes (P<0.05). The relationship between SHR and the recurrence of mild AIS was further explored in the total population of elderly patients with mild AIS, divided into 4 subgroups at intervals of SHR=1.00, 1.40, 1.80. The results showed that SHR=1.41-1.80 and >1.80 were more likely to affect the 1-year recurrence of mild AIS in elderly patients than SHR≤1.0 (P<0.05), and SHR had no interaction with whether there was a history of diabetes (Pinteraction>0.05, Ptrend<0.05, OR=1.627) . Conclusion Regardless of whether elderly young AIS patients have diabetes, SHR has a consistent impact on the recurrence of elderly young AIS patients within one year, and both are its independent influencing factors; compared with stress blood glucose, SHR has a wider range of applications. The higher the SHR (increasing by 0.4 each time), the greater the risk of recurrence within one year for elderly young AIS patients (increasing by 0.627 times) .
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