Background and Purpose: Stress
hyperglycemia is relative
hyperglycemia after suffering an acute illness such as
stroke, even without preexisting diabetes. Our study aimed to determine the relationship between stress
hyperglycemia and outcome of non-diabetic patients with
acute ischemic stroke. Methods: Data were derived from the ACROSS-China (Abnormal
Glucose Regulation in Patients with
Acute Stroke across China) registry. Patients with
ischemic stroke but without a history of
diabetes mellitus were included in this analysis. Stress
hyperglycemia was measured by
glucose-to-
glycated hemoglobin (HbA1c) ratio which was calculated by fasting plasma
glucose (FPG) divided by HbA1c. We investigated the association between quartiles of glucose-to-HbA1c ratio and
stroke recurrence and all-cause death at 12 months after
stroke onset. Results: We included a total of 999 patients, among which there were 105 (10.9%) recurrent
strokes and 76 (7.6%) deaths at 12 months. Using the lowest quartile of glucose-to-HbA1c ratio as the reference, patients with the highest quartile were associated with an increased risk of
stroke recurrence [16.0 vs. 8.3%; adj.hazards ratio (HR) = 2.19, 95% confidence interval (CI): 1.26-3.83] and death (13.0 vs. 4.3%; adj.HR=2.86, 95%CI: 1.38-5.90) at 12 months after adjusted for potential covariates. We also observed that a higher level of glucose-to-HbA1c ratio was associated with an elevated risk of
stroke recurrence and death. Conclusion: Stress
hyperglycemia, measured by glucose-to-HbA1c ratio, was related to an elevated risk of
stroke recurrence and all-cause death in patients with
acute ischemic stroke but without diabetes.