Effects of Diabetes Mellitus and Admission Glucose in Patients Receiving Mechanical Thrombectomy: A Systematic Review and Meta-analysis
We performed a meta-analysis to evaluate the outcomes of acute ischemic stroke (AIS) in patients treated with mechanical thrombectomy (MT), according to diabetes mellitus and admission glucose level (AGL).
We systematically reviewed previous studies in PubMed that reported outcomes of MT in AIS patients and their relationships with diabetes mellitus or AGL. We used functional independence (modified Rankin score ≤ 2 at 3 months) as the primary end point.
Data from 12,653 patients in 47 articles that evaluated the effect of diabetes mellitus or AGL on outcomes after MT were included. Compared with patients without a history of diabetes mellitus, patients with a diabetes mellitus history had significantly lower odds of functional independence in both the unadjusted meta-analysis (odds ratio [OR] 0.64; 95% confidence interval [CI] 0.54–0.75) and the multivariable analysis (OR 0.48; 95% CI 0.33–0.71). Similarly, higher AGL was associated with an unfavorable functional outcome in the unadjusted meta-analysis (pooled effect size − 0.38; 95% CI − 0.45 to − 0.31), and the adjusted OR (95% CI) per 1 mmol/L increase in AGL was 0.87 (0.83–0.92) for functional independence according to the combined multivariable results. Recanalization rate and symptomatic intracranial hemorrhage were neither related to AGL nor different in patients with or without diabetes mellitus.
The present study confirms that a history of diabetes mellitus and high AGL are associated with unfavorable functional outcomes at 3 months after MT in AIS patients. However, the causal relationship between hyperglycemia and poor prognosis remains undetermined, and further investigations are required to ascertain whether AIS patients receiving MT could benefit from intensive glucose control.
KeywordsAcute ischemic stroke Mechanical thrombectomy Diabetes mellitus Admission glucose Meta-analysis
We would like to thank Jin Xu from Nanjing Medical University for his advices on statistical analysis.
GDL was responsible for study design, literature search, data extraction, data analysis and manuscript drafting. ZQR was responsible for literature search, data extraction and manuscript drafting. JXZ was responsible for data analysis and manuscript drafting. QQZ was responsible for manuscript drafting and manuscript revision. HBS was responsible for study design, study supervision, manuscript drafting and manuscript revision.
Source of Support
This research received no specific grant from any funding agency.
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Conflict of interest
All authors have no conflict of interest to declare.