ArticleBMJ neurology open2026
Association between acute-phase glycaemic metrics and stroke-associated pneumonia in patients with acute ischaemic stroke.
Article in BMJ neurology open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Despite advances in acute ischaemic stroke (AIS) care, stroke-associated pneumonia (SAP) remains a common infectious complication. In this study, we evaluated the relationship between SAP and acute-phase glycaemic variability in patients with AIS. Methods: We analysed 297 consecutive patients with AIS who underwent blood glucose monitoring four times daily for a minimum of 5 days. SAP was defined based on the modified Centers for Disease Control and Prevention criteria. The mean of all glucose measurements was 'BG_mean'. Glycaemic variability was assessed using several metrics, including the SD of glucose values (BG_SD), coefficient of variation (BG_CV), time in range, hyperglycaemia ratio and mean amplitude of glycaemic excursion (MAGE). Results: SAP occurred in 51 individuals (17.2%) of the 297 patients. In the multivariable logistic regression analysis, BG_mean (adjusted OR (aOR)=1.47, 95% CI 1.17 to 1.84) remained a significant predictor of SAP after adjusting for confounders. BG_SD (aOR=1.54, 95% CI 1.10 to 2.15), hyperglycaemia ratio (aOR=1.03, 95% CI 1.01 to 1.05) and MAGE (aOR=1.24, 95% CI 1.04 to 1.49) were strongly associated with SAP, independently of BG_mean. To improve the predictive power of the original A2DS2 score for SAP, we developed new predictive models by assigning additional points based on the cut-off values of individual glycaemic metrics. Among these models, only the model incorporating MAGE showed a significant improvement compared with the original A2DS2 score (p=0.03). Conclusions: Elevated acute-phase glucose levels and glycaemic variability are associated with SAP in patients with AIS.
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