Background and Aims

Acute stress hyperglycemia increases risks of in-hospital mortality after ischemic stroke, and hyperglycemia is one of the most important factors for intracranial artery stenosis (ICAS). This study evaluated the relationship between stress hyperglycemia ratio (SHR) with and without intracranial atherosclerotic stenosis (ICAS) and the prognosis of patients with minor stroke.

Methods

This is a multicenter retrospective observational cohort study. Patients with imaging of eligible CTA and MRA who had acute minor ischemic stroke were enrolled. SHR was calculated as admission blood glucose (ABG) divided by estimated average glucose (EAG). EAG was estimated with HbA1c: [EAG= (1.59 x HbA1c)-2.59], derived by previous reports.

The primary outcome was stroke recurrence during hospitalization. The interaction of SHR levels with presence of ICAS on the primary outcome was investigated with the use of multivariable Cox proportional hazards models. Restricted cubic splines (RCS) were applied to determine the nonlinear relationship between SHR and primary outcome. A two-piecewise linear regression model was used to define the SHR threshold.

Results

Among 660 participants included, 189 (30.98%) has ICAS. In ICAS patients, each 0.1 unit increase in SHR was associated with a 0.46-fold increase in the risk of recurrence (HR,1.46,95% CI,1.32-1.62, P<0.001). There was a significant interaction between SHR levels and ICAS (p=0.002). The results of sensitive analysis were consistent after adjusting Diabetes Mellitus. In RCS analysis, higher level of SHR was associated with an increased risk of recurrence with a threshold of 0.75.

Conclusions

SHR was significantly associated with higher risk of recurrence of stroke in patients with ICAS.