ArticlePloS one2025
The influence of stress hyperglycemia on consciousness disturbance and short- and long-term outcomes in stroke patients without documented diabetes: Differences between ischemic and hemorrhagic stroke.
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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5 citing papers in PubMed.
- A disappearing diabetes: extreme and reversible hyperglycemia during an ulcerative colitis flare.JCEM case reports · 2026Article
- Prognostic Implications of Vancomycin Therapeutic Drug Monitoring for Critically Ill Stroke Patients: Evidence From a Subtype-Oriented Analysis.CNS neuroscience & therapeutics · 2026Article
- Association of leuko-glycemic index with mortality in critically ill stroke patients: analysis from the MIMIC-IV database and an institutional cohort.Frontiers in medicine · 2026Article
- Prognostic significance and temporal patterns of glycemic variability in critically ill non-diabetic patients with ischemic stroke: a retrospective multicenter cohort study.Frontiers in neurologyArticle
- DIFFERENTIAL METABOLIC AND INFLAMMATORY RESPONSES TO ACUTE HYPERGLYCAEMIA IN ISCHAEMIC STROKE: IMPLICATIONS FOR DIABETES STRATIFICATION AND EARLY PROGNOSTICATION.Acta endocrinologica (Bucharest, Romania : 2005)Article
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Abstract
backgroundAlthough hyperglycemia is a well-known prognostic factor in diabetic stroke patients, its impact on outcomes in individuals without documented diabetes remains insufficiently explored. This study aimed to investigate the relationship between stress-induced hyperglycemia and both short- and long-term mortality, as well as impaired consciousness, in patients without documented diabetes with ischemic or hemorrhagic stroke.
methodsA retrospective cohort study was conducted using the MIMIC-IV (v3.1) database, including ICU-admitted patients without documented diabetes (ischemic or hemorrhagic stroke identified via ICD-9/10 codes). Exclusion criteria were: age < 18 years, missing glucose values, and severe impairment of consciousness upon ICU admission, defined as a Glasgow Coma Scale (GCS) score < 8. After applying these criteria, 4,151 patients were enrolled. Propensity score matching (PSM) was performed to balance baseline covariates between the hyperglycemic (HG) and non-hyperglycemic (Non-HG) groups. Cox proportional hazards models and Kaplan-Meier survival curves were used to assess the impact of hyperglycemia on mortality and neurological outcomes. Then subgroup analysis was conducted.
resultsFollowing PSM, 1,170 matched pairs were analyzed. In patients with hemorrhagic stroke (HS), stress hyperglycemia was associated with an increased 1-year mortality risk (HR = 0.71, p = 0.029). Among ischemic stroke (IS) patients, hyperglycemia independently predicted both in-hospital and 1-year mortality (HR range: 0.65-0.79, p < 0.001). Kaplan-Meier analyses showed significantly poorer survival in hyperglycemic patients. Subgroup analysis demonstrated that stress hyperglycemia was particularly detrimental in HS patients with heart failure, pneumonia, vasopressin use, or severe neurological impairment (GCS < 8 with heart failure). In IS patients, hyperglycemia was significantly associated with worse outcomes in those with advanced age, coronary artery disease, COPD, pneumonia, renal failure, or norepinephrine treatment.
conclusionStress hyperglycemia independently predicts poor outcomes in stroke without documented diabetes, especially in ischemic subtypes. These findings highlight the importance of early glycemic assessment and tailored management strategies. Further research is warranted to validate causal mechanisms. In hemorrhagic stroke, its impact appears more delayed, affecting long-term prognosis. These findings support the need for early recognition and tailored glycemic control strategies based on stroke subtype.
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