Association between prediabetes and higher risk of mortality following acute ischemic stroke: A meta-analysis

BACKGROUND Prediabetes increases the risk of cardiovascular and cerebrovascular mortality. This study examines the relationship between prediabetes and mortality in post-stroke patients. AIM To determine whether prediabetes is associated with increased post-stroke mortality in adults with acute ischemic stroke (IS). METHODS A systematic search was conducted in PubMed/MEDLINE, Scopus, and Google Scholar databases until May 2023 to identify relevant articles reporting on the association of prediabetes with IS mortality. A random-effects model was used to calculate odds ratio (OR), heterogeneity was assessed using I 2 statistics, and sensitivity analysis was performed using the leave-one-out method. RESULTS Our analysis of 11 studies included 84833 prediabetic patients with a mean follow-up time of 20.9 months. The prediabetes cohort comprised patients of an average age of 67 years from various countries, including Korea, Italy, Japan, China, Spain, and the Netherlands. Although, the unadjusted analysis showed no significant association between prediabetes and post-stroke mortality (OR = 1.06, 95%CI: 0.51-2.19) with high heterogeneity (I 2 = 94.7%, P < 0.01). Post-adjustment for baseline characteristics and comorbidities, the prediabetes cohort exhibited a significantly higher risk of post-stroke mortality (adjusted OR = 1.68, 95%CI: 1.29-2.19) with moderate heterogeneity (I 2 = 49.45%, P = 0.03). Subgroup analysis by country revealed non-significant higher odds of mortality in Korea, Italy, Spain, Japan, and the Netherlands, indicating the need for more extensive studies. CONCLUSION Our findings suggest that prediabetes is associated with a nearly 68% higher mortality risk following a stroke. Thereby warranting more prospective studies with prediabetes to validate these findings.