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Effects of Diabetes Mellitus and Admission Glucose in Patients Receiving Mechanical Thrombectomy: A Systematic Review and Meta-analysis

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Abstract

Background

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).

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgements

We would like to thank Jin Xu from Nanjing Medical University for his advices on statistical analysis.

Funding

This research received no specific grant from any funding agency.

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Author notes

  1. Guang-Dong Lu and Zi-Qi Ren have contributed equally to this work.

Authors and Affiliations

  1. Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, Jiangsu, China

    Guang-Dong Lu, Jin-Xing Zhang, Qing-Quan Zu & Hai-Bin Shi

  2. School of Nursing, Nanjing Medical University, Nanjing, 210029, China

    Zi-Qi Ren

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  1. Guang-Dong Lu
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Contributions

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.

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Correspondence to Hai-Bin Shi.

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Lu, GD., Ren, ZQ., Zhang, JX. et al. Effects of Diabetes Mellitus and Admission Glucose in Patients Receiving Mechanical Thrombectomy: A Systematic Review and Meta-analysis. Neurocrit Care 29, 426–434 (2018). https://doi.org/10.1007/s12028-018-0562-4

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  • DOI: https://doi.org/10.1007/s12028-018-0562-4

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