Stress Hyperglycemia Ratio Predicts Neurological Deterioration during Stroke Patient Hospitalization

Abstract

Abstract Background: Clinical parameters have been largely studied as a prognostic biomarker for stroke patients. Stress hyperglycemia ratio (SHR) is one of potential and affordable biomarkers to predict acute ischemic stroke outcome. Its ability to predict neurological deterioration in acute ischemic stroke remain demonstrates variable results in previous studies particularly in diabetic group. This research aims to study the association between SHR and neurological deterioration in ischemic stroke patient during hospitalization, especially in Indonesia population. Methods: This is a retrospective cohort utilizing in-patient data from Stoke Unit Registry of Sardjito General Hospital from January 2020 until December 2022 to obtain first-ever ischemic stroke. The researchers applied inclusion and exclusion criteria for the subjects. Stress hyperglycemia ratio represents ratio between random blood glucose at admission and estimated mean glucose. Neurological deterioration is at discharge and admission difference of NIHSS (National Institutes of Health Stroke Scale) or Delta NIHSS. Results: Of the 207 subjects who met criteria, there was 15.5% incidence of neurological deterioration during acute care (mean 5 days). Most subjects (85%) had mild and moderate NIHSS (score 0-15), and ASPECT score >7 (78.3%). The DM group was 32.9%. Hyperglycemia and increased SHR were more prevalent in the DM group. SHR with a cut-off of 1,147 was associated with neurological deterioration with a sensitivity of 50% and specificity of 71.4% (OR=2.14, p=0.017). Hyperglycemia, DM, HbA1c, and baseline NIHSS had no significant association with neurological deterioration (p>0,05). On subgroup analysis, SHR with the same cut-off had a significant association (p<0.009, OR=3.77) only in the non-DM group. Other variables associated with neurological worsening were dyslipidemia (OR=0.414, p=0.042) and sepsis (OR=4.827, p=0.031). Conclusion: SHR predicts neurological deterioration in the first-ever acute ischemic stroke population. In subgroup analysis SHR is significantly associated with neurological deterioration in non-DM group only.