Blood Glucose Levels and Stroke Severity in Patients with Acute Small Subcortical Infarct

Introduction: Hyperglycemia is a common finding in patients with acute ischemic stroke and has been associated with poor outcomes, but its relationship with stroke severity at presentation is unclear. We investigated the associations between blood glucose levels and stroke severity in patients with acute small subcortical infarct (SSI). Methods: We retrospectively reviewed records of consecutive patients with acute SSI admitted to six Stroke Units. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Outcomes of interest were as follows: NIHSS ≥ 7 at admission; increasing NIHSS quartiles at discharge. Independent associations between baseline glucose levels and stroke severity at presentation and discharge were assessed with logistic and ordinal regression, adjusting for age, sex, hypertension, diabetes, smoke exposure, and functional independence. Results: We included 792 patients: mean (±SD) age of 69.8 (±13) years, 548 (69%) males, median (IQR) NIHSS = 4(2–6). The mean blood glucose level at admission was 130 (±59) mg/dL. Patients with moderate–severe NIHSS had higher baseline blood glucose levels compared to those with lower NIHSS (148 mg/dL vs. 125 mg/dL, p < 0.001). After adjusting for confounders, glucose levels ≥ 130 mg/dL and the highest blood glucose quartile were associated with baseline NIHSS ≥ 7 (OR = 1.61; 95%CI = 1.04–2.51; OR = 1.80; 95%CI = 1.13–2.89, respectively). Glucose levels ≥ 130 mg/dL and the highest blood glucose quartile were associated with a shift towards higher NIHSS at discharge (cOR = 1.54; 95%CI = 1.11–2.14; cOR = 1.61; 95%CI = 1.14–2.29, respectively). Conclusions: In patients with acute SSI, higher blood glucose levels are associated with greater stroke severity at both admission and discharge, suggesting a potential biological link between blood glucose and the severity of SSI.