Impact of admission hyperglycemia on clinical outcomes in patients with acute large ischemic stroke undergoing endovascular treatment

BACKGROUND: This study aimed to explore the impact of admission hyperglycemia on clinical outcomes in patients with acute large ischemic stroke undergoing endovascular treatment (EVT). METHODS: Patients with admission blood glucose levels were obtained from a prospective cohort study. We defined admission hyperglycemia as blood glucose levels ≥ 7.8 mmol/L. The primary effectiveness outcome was ordinal modified Rankin Scale (mRS) score at 90 days. Secondary effectiveness outcomes included other clinical outcomes (mRS 0-2, mRS 0-3, mRS 0-4) at 90 days. Safety outcomes were mortality at 90 days, and symptomatic intracerebral hemorrhage (sICH) within 48 h. RESULTS: Among the 478 patients with recorded admission blood glucose levels, 186 (38.9%) presented with hyperglycemia at admission. Multivariable logistic regression analysis showed a significant inverse association between admission hyperglycemia and the distribution of mRS at 90 days (adjusted odds ratio [aOR], 0.46; 95% CI 0.31-0.67; P < 0.001). Additionally, admission hyperglycemia was significantly associated with increased mortality (aOR, 2.29; 95% CI 1.47-3.57; P < 0.001) and the occurrence of sICH (aOR, 2.08; 95% CI 1.15-3.76; P = 0.015). Restricted cubic spline regression analysis indicated that blood glucose levels exhibited a nonlinear association with sICH, whereas admission hyperglycemia showed a linear relationship with mRS 0-3, mRS 0-2, and mortality. CONCLUSIONS: Our results demonstrated that admission hyperglycemia was associated with poor clinical outcomes in patients with acute large ischemic stroke who underwent EVT. This finding suggests that admission hyperglycemia may serve as a valuable prognostic indicator for EVT outcomes and can help inform timely preventive interventions.