Cargando…
Measuring of Advanced Glycation End Products in Acute Stroke Care: Skin Autofluorescence as a Predictor of Ischemic Stroke Outcome in Patients with Diabetes Mellitus
Background: Patients with diabetes mellitus (DM) are known to show poor recovery after stroke. This specific burden might be due to acute and chronic hyperglycemic effects. Meanwhile, the underlying mechanisms are a cause of discussion, and the best measure to predict the outcome is unclear. Skin au...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8955850/ https://www.ncbi.nlm.nih.gov/pubmed/35329949 http://dx.doi.org/10.3390/jcm11061625 |
_version_ | 1784676437687533568 |
---|---|
author | Filipov, Alexandra Fuchshuber, Heike Kraus, Josephine Ebert, Anne D. Sandikci, Vesile Alonso, Angelika |
author_facet | Filipov, Alexandra Fuchshuber, Heike Kraus, Josephine Ebert, Anne D. Sandikci, Vesile Alonso, Angelika |
author_sort | Filipov, Alexandra |
collection | PubMed |
description | Background: Patients with diabetes mellitus (DM) are known to show poor recovery after stroke. This specific burden might be due to acute and chronic hyperglycemic effects. Meanwhile, the underlying mechanisms are a cause of discussion, and the best measure to predict the outcome is unclear. Skin autofluorescence (SAF) reflects the in-patient load of so-called advanced glycation end products (AGEs) beyond HbA1c and represents a valid and quickly accessible marker of chronic hyperglycemia. We investigated the predictive potential of SAF in comparison to HbA1c and acute hyperglycemia on the functional outcome at 90 days after ischemic stroke in a cohort of patients with DM. Methods: We prospectively included 113 patients with DM type 2 hospitalized for acute ischemic stroke. SAF was measured on each patient’s forearm by a mobile AGE-Reader mu© in arbitrary units. HbA1c and the area under the curve (AUC) of the blood sugar profile after admission were assessed. Functional outcome was assessed via phone interview after 90 days. A poor outcome was defined as a deterioration to a modified Rankin Scale score ≥ 3. A good outcome was defined as a modified Rankin Scale score < 3 or as no deterioration from premorbid level. Results: Patients with a poor outcome presented with higher values of SAF (mean 3.38 (SD 0.55)) than patients with a good outcome (mean 3.13 (SD 0.61), p = 0.023), but did not differ in HbA1c and acute glycemia. In logistic regression analysis, age (p = 0.021, OR 1.24 [1.12–1.37]) and SAF (p = 0.021, OR 2.74 [1.16–6.46]) significantly predicted a poor outcome, whereas HbA1c and acute glycemia did not. Patients with a poor 90-day outcome and higher SAF experienced more infections (4.2% vs. 33.3% (p < 0.01)) and other various in-hospital complications (21.0% vs. 66.7% (p < 0.01)) than patients with a good outcome and lower SAF levels. Conclusions: SAF offers an insight into glycemic memory and appears to be a significant predictor of poor stroke outcomes in patients with DM exceeding HbA1c and acute glycemia. Measuring SAF could be useful to identify specifically vulnerable patients at high risk of complications and poor outcomes. |
format | Online Article Text |
id | pubmed-8955850 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-89558502022-03-26 Measuring of Advanced Glycation End Products in Acute Stroke Care: Skin Autofluorescence as a Predictor of Ischemic Stroke Outcome in Patients with Diabetes Mellitus Filipov, Alexandra Fuchshuber, Heike Kraus, Josephine Ebert, Anne D. Sandikci, Vesile Alonso, Angelika J Clin Med Article Background: Patients with diabetes mellitus (DM) are known to show poor recovery after stroke. This specific burden might be due to acute and chronic hyperglycemic effects. Meanwhile, the underlying mechanisms are a cause of discussion, and the best measure to predict the outcome is unclear. Skin autofluorescence (SAF) reflects the in-patient load of so-called advanced glycation end products (AGEs) beyond HbA1c and represents a valid and quickly accessible marker of chronic hyperglycemia. We investigated the predictive potential of SAF in comparison to HbA1c and acute hyperglycemia on the functional outcome at 90 days after ischemic stroke in a cohort of patients with DM. Methods: We prospectively included 113 patients with DM type 2 hospitalized for acute ischemic stroke. SAF was measured on each patient’s forearm by a mobile AGE-Reader mu© in arbitrary units. HbA1c and the area under the curve (AUC) of the blood sugar profile after admission were assessed. Functional outcome was assessed via phone interview after 90 days. A poor outcome was defined as a deterioration to a modified Rankin Scale score ≥ 3. A good outcome was defined as a modified Rankin Scale score < 3 or as no deterioration from premorbid level. Results: Patients with a poor outcome presented with higher values of SAF (mean 3.38 (SD 0.55)) than patients with a good outcome (mean 3.13 (SD 0.61), p = 0.023), but did not differ in HbA1c and acute glycemia. In logistic regression analysis, age (p = 0.021, OR 1.24 [1.12–1.37]) and SAF (p = 0.021, OR 2.74 [1.16–6.46]) significantly predicted a poor outcome, whereas HbA1c and acute glycemia did not. Patients with a poor 90-day outcome and higher SAF experienced more infections (4.2% vs. 33.3% (p < 0.01)) and other various in-hospital complications (21.0% vs. 66.7% (p < 0.01)) than patients with a good outcome and lower SAF levels. Conclusions: SAF offers an insight into glycemic memory and appears to be a significant predictor of poor stroke outcomes in patients with DM exceeding HbA1c and acute glycemia. Measuring SAF could be useful to identify specifically vulnerable patients at high risk of complications and poor outcomes. MDPI 2022-03-15 /pmc/articles/PMC8955850/ /pubmed/35329949 http://dx.doi.org/10.3390/jcm11061625 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Filipov, Alexandra Fuchshuber, Heike Kraus, Josephine Ebert, Anne D. Sandikci, Vesile Alonso, Angelika Measuring of Advanced Glycation End Products in Acute Stroke Care: Skin Autofluorescence as a Predictor of Ischemic Stroke Outcome in Patients with Diabetes Mellitus |
title | Measuring of Advanced Glycation End Products in Acute Stroke Care: Skin Autofluorescence as a Predictor of Ischemic Stroke Outcome in Patients with Diabetes Mellitus |
title_full | Measuring of Advanced Glycation End Products in Acute Stroke Care: Skin Autofluorescence as a Predictor of Ischemic Stroke Outcome in Patients with Diabetes Mellitus |
title_fullStr | Measuring of Advanced Glycation End Products in Acute Stroke Care: Skin Autofluorescence as a Predictor of Ischemic Stroke Outcome in Patients with Diabetes Mellitus |
title_full_unstemmed | Measuring of Advanced Glycation End Products in Acute Stroke Care: Skin Autofluorescence as a Predictor of Ischemic Stroke Outcome in Patients with Diabetes Mellitus |
title_short | Measuring of Advanced Glycation End Products in Acute Stroke Care: Skin Autofluorescence as a Predictor of Ischemic Stroke Outcome in Patients with Diabetes Mellitus |
title_sort | measuring of advanced glycation end products in acute stroke care: skin autofluorescence as a predictor of ischemic stroke outcome in patients with diabetes mellitus |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8955850/ https://www.ncbi.nlm.nih.gov/pubmed/35329949 http://dx.doi.org/10.3390/jcm11061625 |
work_keys_str_mv | AT filipovalexandra measuringofadvancedglycationendproductsinacutestrokecareskinautofluorescenceasapredictorofischemicstrokeoutcomeinpatientswithdiabetesmellitus AT fuchshuberheike measuringofadvancedglycationendproductsinacutestrokecareskinautofluorescenceasapredictorofischemicstrokeoutcomeinpatientswithdiabetesmellitus AT krausjosephine measuringofadvancedglycationendproductsinacutestrokecareskinautofluorescenceasapredictorofischemicstrokeoutcomeinpatientswithdiabetesmellitus AT ebertanned measuringofadvancedglycationendproductsinacutestrokecareskinautofluorescenceasapredictorofischemicstrokeoutcomeinpatientswithdiabetesmellitus AT sandikcivesile measuringofadvancedglycationendproductsinacutestrokecareskinautofluorescenceasapredictorofischemicstrokeoutcomeinpatientswithdiabetesmellitus AT alonsoangelika measuringofadvancedglycationendproductsinacutestrokecareskinautofluorescenceasapredictorofischemicstrokeoutcomeinpatientswithdiabetesmellitus |