Stress hyperglycaemia in non-diabetic patients admitted with stroke is associated with increased morbidity and mortality1,2. The stress hyperglycaemia ratio (SHR), defined as admission glucose divided by estimated average glucose derived from HbA1c, measures relative hyperglycaemia3. Using SHR as a marker of relative hyperglycaemia is a superior biomarker for critical illness outcomes compared to glucose3.
In patients admitted with acute stroke SHR may predict mortality and morbidity.
HbA1c and serum glucose was measured at time of hospital admission in patients with an acute stroke (n=443, 30.7% known diabetes). Endpoints were stroke severity at admission (either modified Rankin 5 at admission (mRS), GCS ≤10, or need for critical care) and poor outcome at discharge (either higher level of care, increased mRS, decreased GCS, stroke extension, haemorrhagic transformation or death). Outcomes were determined for quintiles (Q) classified for SHR and glucose.
Odds ratios for Q5 (highest quintile) vs Q1 (lowest) were 2.94 (p<0.001) and 1.94 (p=0.039) for severity at admission for SHR and glucose respectively, and 2.16 (p=0.004) and 1.94 (p=0.039) for poor outcomes at discharge. Of those admitted with stroke severity (n=22), 25% of Q5 SHR had a poor outcome at discharge compared to 18% (n=18) for Q5 glucose. Identification of stress hyperglycaemia using SHR was independent of HbA1c (6.5+1.6 v 6.3+1.6, p=0.13 for Q1 and Q5 respectively), but not serum glucose (5.6+0.5 v 8.1+2.2, p<0.001).
While both SHR and glucose were associated with stroke severity and poorer outcomes at discharge, SHR was independent of HbA1c. Multivariable analysis enabling direct comparison of SHR and glucose is pending and will be presented. In acute stroke SHR may be a useful prognostic marker and guide individualised glucose lowering therapy targets which may improve stroke outcomes.