Hyperglycemia and Outcomes in Acute Ischemic Stroke Patients

Hyperglycaemia is a frequent finding in the acute phase of ischaemic stroke and constitutes an independent driver of poor neurological outcome. Elevations in blood glucose at presentation reflect both underlying diabetes and stress-induced metabolic dysregulation. Acute hyperglycaemia exacerbates ischaemic injury through lactic acidosis, oxidative stress and blood–brain barrier disruption, while chronic dysglycaemia, as indexed by glycated haemoglobin (HbA1c), predisposes to vascular fragility and impaired collaterals. The interplay of acute and chronic glycaemic factors can be quantified through novel indices such as the acute-to-chronic glycaemic ratio (ACR) and stress hyperglycaemia ratio (SHR), which refine risk stratification beyond absolute glucose values. Observational studies consistently show that higher admission glucose and unfavourable glycaemic ratios are associated with increased rates of haemorrhagic transformation, larger infarct volumes, worse functional status at three months and greater mortality. These findings hold true across treatment modalities, including intravenous thrombolysis and endovascular thrombectomy, and in patients with or without pre-existing diabetes. The global burden of stroke and the modifiable nature of hyperglycaemia underscore the need for standardised monitoring, timely correction of elevated glucose and targeted nutritional interventions to improve recovery trajectories.

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Hyperglycemia and Outcomes in Acute Ischemic Stroke Patients publication trend

The graph below shows the total number of articles in hyperglycemia and outcomes in acute ischemic stroke patients across all publications each year (not limited to Nature Index journals).

Technical terms

Hyperglycaemia: Elevated blood glucose concentration above normal physiological range.

Acute ischaemic stroke: Sudden loss of cerebral blood flow due to arterial occlusion, leading to brain tissue injury.

HbA1c (glycated haemoglobin): A measure of average blood glucose over the preceding two to three months.

Acute-to-chronic glycaemic ratio (ACR): The ratio of admission glucose to estimated chronic glucose derived from HbA1c.

Stress hyperglycaemia ratio (SHR): The quotient of acute blood glucose to an HbA1c-derived chronic glycaemic estimate.

Modified Rankin Scale (mRS): A clinical scale ranging from 0 (no symptoms) to 6 (death) used to assess functional outcome after stroke.

Intravenous thrombolysis (IVT): Administration of clot-dissolving medication directly into the bloodstream to restore cerebral perfusion.

Endovascular thrombectomy (EVT): A mechanical procedure to remove an obstructing clot from a cerebral artery using specialised devices.

References

1. Acute-to-chronic glycemic ratio as an outcome predictor in ischemic stroke in patients with and without diabetes mellitus. Cardiovascular Diabetology (2024).
2. Effects of admission hyperglycemia and intravenous thrombolysis allocation in acute basilar artery occlusion after endovascular treatment: Analysis of the ATTENTION registry. Neurotherapeutics (2023).
3. Effect of a diabetes-specific formula in non-diabetic inpatients with stroke: a randomized controlled trial. Nutrition & Diabetes (2024).