Objective: To determine the relationship between stress
hyperglycemia and prognosis of
acute ischemic stroke people with and without diabetes. Methods: A subgroup of 8,622
acute ischemic stroke people with baseline levels of fasting
blood glucose and HbA1c from the China National
Stroke Registry II were analyzed. Stress
hyperglycemia was measured by
glucose/
glycated hemoglobin (HbA1c) ratio, calculated by fasting
blood glucose divided by HbA1c. Diabetes was diagnosed according to medical history or a HbA1c level of ≥6.5%. The outcomes included severe neurological deficit defined as modified Rankin Scale score of 3 to 5 and all-cause death at 1 year. The associations between
glucose/HbA1c ratio and neurological deficit and all-cause death were analyzed via logistic regression model and Cox proportional-hazards model, respectively. Subgroup analyses of participants with or without diabetes were performed separately. Results: Totally 1,189 (13.7%) participants had severe neurological deficit, and 678 (7.9%) died within 1 year. Compared with the lowest quartile, the highest quartiles of
glucose/HbA1c ratio were associated with elevated risk of worse neurological deficit (20.1% vs. 13.0%; adjusted OR, 1.83; 95%CI, 1.31-2.54, p = 0.001), and mortality (12.1% vs. 6.6%; adjusted HR, 2.04; 95% CI, 1.47-2.83, p < 0.0001) after adjusted for potential covariates. The association of
glucose/HbA1c ratio with neurological deficit remained in the participants with and without diabetes, while it was only significant in the participants without diabetes as for the outcome of mortality. Conclusions: Stress
hyperglycemia, measured by
glucose/HbA1c ratio, was associated with increased risk of severe neurological deficit and mortality within 1 year in the
acute ischemic stroke people.