Higher Stress Hyperglycemia Ratio Is Associated With a Higher Risk of Stroke-Associated Pneumonia

Overview

Journal Front Nutr

Specialty Nutritional Sciences

Date 2022 Mar 11

PMID 35273985

Authors

Jiejie Tao

Zhishan Hu

Feiling Lou

Junxin Wu

Zijing Wu

Shuang Yang

Xiaofang Jiang

Meihao Wang

Qiqi Huang

Wenwei Ren

Affiliations

Soon will be listed here.

Abstract

Objective: Stroke-associated pneumonia (SAP) is a frequent complication in stroke patients. This present study aimed to investigate the association between stress hyperglycemia and SAP.

Methods: Patients were screened between February 2013 and August 2020 from the First Affiliated Hospital of Wenzhou Medical University. We divided the blood glucose of the patients at admission by the glycated hemoglobin to calculate the stress hyperglycemia ratio (SHR). Binary logistic regression analysis was used to identify the association between SAP and SHR, with the confounders being controlled. Further, subgroup analyses were separately performed for stroke patients with and without diabetes.

Results: A total of 2,039 patients were finally recruited, of which 533 (26.14%) were diagnosed with SAP. SHR were divided into four quartiles in the logistic regression analysis, the highest SHR quartile (SHR ≥ 1.15) indicated a higher risk of SAP (OR = 1.57; 95% CI = 1.13-2.19, = 0.01) in total patients. In patients without diabetes, the third quantile (SHR = 0.96-1.14) and the highest quantile (SHR ≥ 1.15) were both related to a higher risk of SAP (both < 0.05). However, we did not find such an association in diabetic patients.

Conclusion: SHR was significantly associated with the risk of SAP in patients without diabetes. Adequate attention should be paid to the patients with high SHR levels at admission, especially those without diabetes.

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References

Zhu B, Pan Y, Jing J, Meng X, Zhao X, Liu L . Stress Hyperglycemia and Outcome of Non-diabetic Patients After Acute Ischemic Stroke. Front Neurol. 2019; 10:1003. PMC: 6759951. DOI: 10.3389/fneur.2019.01003. View

Dandona P, Mohanty P, Chaudhuri A, Garg R, Aljada A . Insulin infusion in acute illness. J Clin Invest. 2005; 115(8):2069-72. PMC: 1180564. DOI: 10.1172/JCI26045. View

Emsley H, Hopkins S . Acute ischaemic stroke and infection: recent and emerging concepts. Lancet Neurol. 2008; 7(4):341-53. DOI: 10.1016/S1474-4422(08)70061-9. View

Walter U, Knoblich R, Steinhagen V, Donat M, Benecke R, Kloth A . Predictors of pneumonia in acute stroke patients admitted to a neurological intensive care unit. J Neurol. 2007; 254(10):1323-9. DOI: 10.1007/s00415-007-0520-0. View

Kwan J, Horsfield G, Bryant T, Gawne-Cain M, Durward G, Byrne C . IL-6 is a predictive biomarker for stroke associated infection and future mortality in the elderly after an ischemic stroke. Exp Gerontol. 2013; 48(9):960-5. DOI: 10.1016/j.exger.2013.07.003. View

Morohoshi M, Fujisawa K, Uchimura I, Numano F . Glucose-dependent interleukin 6 and tumor necrosis factor production by human peripheral blood monocytes in vitro. Diabetes. 1996; 45(7):954-9. DOI: 10.2337/diab.45.7.954. View

Lepper P, Ott S, Nuesch E, von Eynatten M, Schumann C, Pletz M . Serum glucose levels for predicting death in patients admitted to hospital for community acquired pneumonia: prospective cohort study. BMJ. 2012; 344:e3397. PMC: 3362658. DOI: 10.1136/bmj.e3397. View

NanZhu Y, Xin L, Xianghua Y, Jun C, Min L . Risk factors analysis of nosocomial pneumonia in elderly patients with acute cerebral infraction. Medicine (Baltimore). 2019; 98(13):e15045. PMC: 6456111. DOI: 10.1097/MD.0000000000015045. View

Samary C, Pelosi P, Silva P, Rocco P . Immunomodulation after ischemic stroke: potential mechanisms and implications for therapy. Crit Care. 2016; 20(1):391. PMC: 5141640. DOI: 10.1186/s13054-016-1573-1. View

10.

Bellis A, Mauro C, Barbato E, Ceriello A, Cittadini A, Morisco C . Stress-Induced Hyperglycaemia in Non-Diabetic Patients with Acute Coronary Syndrome: From Molecular Mechanisms to New Therapeutic Perspectives. Int J Mol Sci. 2021; 22(2). PMC: 7828822. DOI: 10.3390/ijms22020775. View

11.

Esposito K, Nappo F, Marfella R, Giugliano G, Giugliano F, Ciotola M . Inflammatory cytokine concentrations are acutely increased by hyperglycemia in humans: role of oxidative stress. Circulation. 2002; 106(16):2067-72. DOI: 10.1161/01.cir.0000034509.14906.ae. View

12.

Yang C, Liao W, Wang J, Tsai C, Lee J, Peng G . Usefulness of glycated hemoglobin A1c-based adjusted glycemic variables in diabetic patients presenting with acute ischemic stroke. Am J Emerg Med. 2017; 35(9):1240-1246. DOI: 10.1016/j.ajem.2017.03.049. View

13.

Liu D, Chu S, Chen C, Yang P, Chen N, He X . Research progress in stroke-induced immunodepression syndrome (SIDS) and stroke-associated pneumonia (SAP). Neurochem Int. 2018; 114:42-54. DOI: 10.1016/j.neuint.2018.01.002. View

14.

Meisel C, Schwab J, Prass K, Meisel A, Dirnagl U . Central nervous system injury-induced immune deficiency syndrome. Nat Rev Neurosci. 2005; 6(10):775-86. DOI: 10.1038/nrn1765. View

15.

Li J, Quan K, Wang Y, Zhao X, Li Z, Pan Y . Effect of Stress Hyperglycemia on Neurological Deficit and Mortality in the Acute Ischemic Stroke People With and Without Diabetes. Front Neurol. 2020; 11:576895. PMC: 7542306. DOI: 10.3389/fneur.2020.576895. View

16.

Yuan C, Chen S, Ruan Y, Liu Y, Cheng H, Zeng Y . The Stress Hyperglycemia Ratio is Associated with Hemorrhagic Transformation in Patients with Acute Ischemic Stroke. Clin Interv Aging. 2021; 16:431-442. PMC: 7955757. DOI: 10.2147/CIA.S280808. View

17.

Ngiam J, Cheong C, Leow A, Wei Y, Thet J, Lee I . Stress hyperglycaemia is associated with poor functional outcomes in patients with acute ischaemic stroke after intravenous thrombolysis. QJM. 2020; 115(1):7-11. DOI: 10.1093/qjmed/hcaa253. View

18.

Prass K, Meisel C, Hoflich C, Braun J, Halle E, Wolf T . Stroke-induced immunodeficiency promotes spontaneous bacterial infections and is mediated by sympathetic activation reversal by poststroke T helper cell type 1-like immunostimulation. J Exp Med. 2003; 198(5):725-36. PMC: 2194193. DOI: 10.1084/jem.20021098. View

19.

Tsai Y, Wu S, Hsieh T, Liu H, Huang C, Chou S . Association of Stress-Induced Hyperglycemia and Diabetic Hyperglycemia with Mortality in Patients with Traumatic Brain Injury: Analysis of a Propensity Score-Matched Population. Int J Environ Res Public Health. 2020; 17(12). PMC: 7345992. DOI: 10.3390/ijerph17124266. View

20.

Garner J, Jarvis W, Emori T, Horan T, Hughes J . CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988; 16(3):128-40. DOI: 10.1016/0196-6553(88)90053-3. View