Background: Stress hyperglycemia may deteriorate stroke outcomes, but its impact on the prognosis following mechanical thrombectomy remains unclear. This study aimed to evaluate the effects of stress hyperglycemia on in-hospital and 3-month outcomes in stroke patients with anterior circulation occlusion undergoing mechanical thrombectomy. Methods: A total of 415 patients who had mechanical thrombectomy in the anterior circulation were enrolled. The stress hyperglycemia ratio (SHR) was calculated as the fasting glucose to glycated hemoglobin ratio and was categorized into tertiles (i.e., SHR1–3). In-hospital and 3-month outcomes were compared using multivariable regression models. The impact of SHR stratified by diabetes status was evaluated and the predictive accuracy of the Totaled Health Risks in Vascular Events (THRIVE)-c risk score was explored with the inclusion of SHR. Results: Compared to the SHR1–2 groups, the SHR3 group exhibited significantly higher rates of 24 h symptomatic intracranial hemorrhage (adjusted odds ratio [aOR], 4.088; 95% confidence interval [CI], 1.551–10.772; p = 0.004) and 72 h early neurological deterioration (aOR, 3.505; 95% CI, 1.984–6.192; p < 0.001), while the incidence of post-stroke pneumonia did not differ significantly between the groups (aOR, 1.379; 95% CI, 0.838–2.268; p = 0.206). At three months, the SHR3 group had a worse distribution of modified Rankin scale (aOR, 2.261; 95% CI, 1.495–3.421; p < 0.001) and faced a higher risk of functional dependence (adjusted hazard ratio [aHR], 1.629; 95% CI, 1.230–2.158; p = 0.001) as well as all-cause mortality (aHR, 1.986; 95% CI, 1.235–3.194; p = 0.005). The adverse effects of an elevated SHR were more pronounced in non-diabetic patients, and incorporating SHR significantly enhanced the predictive accuracy of the THRIVE-c score for poor stroke outcomes. Conclusions: Stress hyperglycemia could be related to the risks of in-hospital complications and 3-month poor outcomes following mechanical thrombectomy in the anterior circulation.

Background Stress hyperglycemia may deteriorate stroke outcomes, but the effects of this condition on prognosis of mechanical thrombectomy remain undetermined. This study aimed to evaluate the impacts of stress hyperglycemia on in-hospital and 3-month outcomes of mechanical thrombectomy in stroke patients due to anterior circulation occlusion. Methods A total of 415 patients undergoing mechanical thrombectomy in the anterior circulation were enrolled. Stress hyperglycemia ratio (SHR) was measured with fasting glucose/glycated hemoglobin ratio and grouped as tertiles (i.e., SHR1–3) to compare in-hospital and 3-month outcomes using multivariable regression models. The effect of SHR stratified by diabetes status and the added value of SHR on the Totaled Health Risks in Vascular Events (THRIVE)-c risk score were also explored. Results The SHR3 group compared with the SHR1–2 group showed increased 24h symptomatic intracranial hemorrhage (adjusted odds ratio [aOR], 4.088; 95% confidence interval [CI], 1.551–10.772; P = 0.004), increased 72h early neurological deterioration (aOR, 3.505; 95% CI, 1.984–6.192; P < 0.001), and a similar incidence of post-stroke pneumonia (aOR, 1.379; 95% CI, 0.838–2.268; P = 0.206). At three months, patients in the SHR3 group had a worse distribution of modified Rankin scale (aOR, 2.261; 95% CI, 1.495–3.421; P < 0.001), and were at a higher risk of unfavorable functional outcome (adjusted hazard ratio [aHR], 1.629; 95% CI, 1.230–2.158; P = 0.001) and all-cause mortality (aHR, 1.986; 95% CI, 1.235–3.194; P = 0.005). The adverse effects of SHR were more often observed in non-diabetic patients, and including SHR significantly improved the accuracy of the THRIVE-c score for predicting poor stroke outcomes. Conclusions Stress hyperglycemia is related to the risks of in-hospital and 3-month poor outcomes after receiving mechanical thrombectomy in the anterior circulation.