Article Impact Level: HIGH Data Quality: STRONG Summary of Cardiovascular Diabetology, 23(1), 206. https://doi.org/10.1186/s12933-024-02260-9 Dr. Elisenda Climent et al.
Points
- The study analyzed the acute-to-chronic glycemic ratio (ACR) in 2,774 acute ischemic stroke (AIS) patients and categorized them into three tertiles based on ACR values.
- Factors such as age, diabetes presence, prior disability, initial stroke severity, and revascularization therapy were significantly associated with poor outcomes.
- Each 0.1 increase in ACR was linked to a 7% higher risk of poor outcomes, with patients in the highest ACR tertile having a worse prognosis and increased mortality.
- Despite the association between higher ACR and poor outcomes, adding ACR to traditional clinical models did not significantly improve the predictive accuracy of stroke prognosis.
- The study concludes that while ACR is a risk indicator, it only enhances prognostic value beyond comprehensive clinical assessment models.
Summary
In a retrospective study conducted at Hospital del Mar in Barcelona, researchers investigated the impact of the acute-to-chronic glycemic ratio (ACR) on the prognosis of patients with acute ischemic stroke (AIS). Utilizing historical health records, the study analyzed plasma glucose levels at admission and estimated chronic glucose levels (eCGL) using the formula [28.7 x HbA1c (%)] – 46.7. The ACR was calculated by dividing the admission glucose level by the eCGL. Patients were categorized into three tertiles based on their ACR values: 0.28–0.92 for tertile 1, 0.92–1.13 for tertile 2, and greater than 1.13 for tertile 3. A poor prognosis three months post-stroke was defined as a modified Rankin Scale (mRS) score between 3 and 6.
The study included 2,774 subjects diagnosed with AIS, where factors such as age, presence of diabetes, prior disability (mRS), initial severity of stroke (measured by NIHSS score), and revascularization therapy were found to be significantly associated with poor outcomes (p < 0.05). The findings demonstrated that each 0.1 increase in the ACR was linked to a 7% increase in the risk of a poor outcome. Notably, patients in the highest ACR tertile (tertile 3) were independently associated with a worse prognosis and increased mortality. However, when the ACR variable was added to the classical clinical model for predicting stroke outcomes, there was no significant improvement in the predictive accuracy of the prognosis (ROC curve AUC: 0.786 vs. 0.781).
This analysis indicates that while a higher ACR is associated with poorer outcomes and increased mortality three months following an AIS, incorporating ACR into the predictive model does not enhance the prognostic value beyond traditional clinical variables. These results suggest that while ACR can serve as an indicator of risk, it may not provide additional predictive benefit in clinical settings where comprehensive assessment models are already employed.
Link to the article: https://cardiab.biomedcentral.com/articles/10.1186/s12933-024-02260-9
References Climent, E., Rodriguez-Campello, A., Jiménez-Balado, J., Fernández-Miró, M., Jiménez-Conde, J., Llauradó, G., Ois, Á., Flores, J. A., Cuadrado-Godia, E., Steinhauer, E. G., Chillarón, J. J., Perez, I. F., Gomez, A. M., Perez, A. S., Alonso, D. G., Prats, M. V., & Neurovascular Research Group (NEUVAS). (2024). Acute-to-chronic glycemic ratio as an outcome predictor in ischemic stroke in patients with and without diabetes mellitus. Cardiovascular Diabetology, 23(1), 206. https://doi.org/10.1186/s12933-024-02260-9
