Abstract
Background and aims
Chronic glycemic dysregulation, reflected by elevated glycated hemoglobin (HbA1c), has been linked to unfavorable outcomes after acute ischemic stroke (AIS). However, most studies rely on heterogeneous HbA1c thresholds, limiting comparability and biological interpretation. The Objective was to evaluate the dose-response association between admission HbA1c levels and poor functional outcome (modified Rankin Scale [mRS] 3–6) in patients with AIS using an exploratory meta-analysis.
Methods
A systematic search of PubMed, Scopus, and Embase was conducted without language restrictions, prioritizing studies published within the last five years. Studies reporting HbA1c as a continuous variable and functional outcome assessed by the mRS were eligible. Two observational cohort studies met strict inclusion criteria and were included in the quantitative synthesis. Effect estimates were harmonized to reflect the odds of poor functional outcome per 1-unit increase in HbA1c. A random-effects model was applied.
Results
Across the two included studies, each 1-unit increase in admission HbA1c was associated with a higher likelihood of poor functional outcome (pooled OR 1.20; 95% CI 1.01-1.43). Moderate heterogeneity was observed (I2 = 66.8%). Despite the limited number of studies, the direction of effect was consistent.
Conclusions
In this exploratory dose-response meta-analysis, higher admission HbA1c levels were associated with worse functional outcomes after AIS. These findings support a potential biological gradient between chronic glycemic exposure and post-stroke disability and highlight the need for larger prospective studies evaluating HbA1c as a continuous prognostic marker.
Conflict of interest
Nothing to disclose