Hyperglycaemia and the SOAR stroke score in predicting mortality

Stephen J. McCall, Turkiah A. Alanazi, Allan B. Clark, Stanley D. Musgrave, Joao H. Bettencourt-Silva, Max O. Bachmann, Anthony K Metcalf, Kristian M. Bowles, Mamas A. Mamas, John F. Potter, Phyo K. Myint

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Abstract

Background: We assessed the association between admission blood glucose levels and acute stroke mortality and examined if there was any incremental value of adding glucose status to the validated acute stroke mortality predictor - the SOAR score. Methods: Data from Norfolk and Norwich University Hospital Stroke & TIA register (20032013) and Anglia Stroke Clinical Network Evaluation Study (2009-2012) were analysed. Multivariable analysis assessed the association between admission blood glucose levels with inpatient and 7-day mortality. The prognostic ability of the SOAR score was then compared with the SOAR with glucose score(SOAR-G). Results: A total of 5,575 acute stroke patients(ischaemic stroke 89.2%), with mean age(sd) of 76.97±11.88 years were included. Both borderline hyperglycaemia (7.9-11.0mmol/L) and hyperglycaemia (>11.0mmol/L) when compared to normoglycaemia (4.0-7.8mmol/L), were associated with both 7-day and inpatient mortality after controlling for sex, age, OCSP classification and pre-stroke modified Rankin score. Both the SOAR stroke score and SOAR G were good predictors of inpatient stroke mortality [AUC 0.82(95%CI:0.81-0.84) and 0.83(95%CI:0.81-0.84)], respectively. These scores were also good at predicting outcomes in both patients with and without diabetes. Conclusions: High blood glucose levels at admission were associated with worse acute stroke mortality outcomes. The constituents of the SOAR stroke score were good at predicting mortality after stroke.
Original languageEnglish
Pages (from-to)114-121
Number of pages8
JournalDiabetes and Vascular Disease Research
Volume15
Issue number2
Early online date29 Nov 2017
DOIs
Publication statusPublished - 1 Mar 2018

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Hyperglycemia
Stroke
Mortality
Blood Glucose
Inpatients
Glucose
Area Under Curve

Keywords

  • Hyperglycaemia
  • Prognostic score
  • Stroke mortality

Cite this

McCall, S. J., Alanazi, T. A., Clark, A. B., Musgrave, S. D., Bettencourt-Silva, J. H., Bachmann, M. O., ... Myint, P. K. (2018). Hyperglycaemia and the SOAR stroke score in predicting mortality. Diabetes and Vascular Disease Research, 15(2), 114-121. https://doi.org/10.1177/1479164117743034

Hyperglycaemia and the SOAR stroke score in predicting mortality. / McCall, Stephen J.; Alanazi, Turkiah A.; Clark, Allan B.; Musgrave, Stanley D.; Bettencourt-Silva, Joao H.; Bachmann, Max O.; Metcalf, Anthony K; Bowles, Kristian M.; Mamas, Mamas A.; Potter, John F.; Myint, Phyo K.

In: Diabetes and Vascular Disease Research, Vol. 15, No. 2, 01.03.2018, p. 114-121.

Research output: Contribution to journalArticle

McCall, SJ, Alanazi, TA, Clark, AB, Musgrave, SD, Bettencourt-Silva, JH, Bachmann, MO, Metcalf, AK, Bowles, KM, Mamas, MA, Potter, JF & Myint, PK 2018, 'Hyperglycaemia and the SOAR stroke score in predicting mortality' Diabetes and Vascular Disease Research, vol. 15, no. 2, pp. 114-121. https://doi.org/10.1177/1479164117743034
McCall SJ, Alanazi TA, Clark AB, Musgrave SD, Bettencourt-Silva JH, Bachmann MO et al. Hyperglycaemia and the SOAR stroke score in predicting mortality. Diabetes and Vascular Disease Research. 2018 Mar 1;15(2):114-121. https://doi.org/10.1177/1479164117743034
McCall, Stephen J. ; Alanazi, Turkiah A. ; Clark, Allan B. ; Musgrave, Stanley D. ; Bettencourt-Silva, Joao H. ; Bachmann, Max O. ; Metcalf, Anthony K ; Bowles, Kristian M. ; Mamas, Mamas A. ; Potter, John F. ; Myint, Phyo K. / Hyperglycaemia and the SOAR stroke score in predicting mortality. In: Diabetes and Vascular Disease Research. 2018 ; Vol. 15, No. 2. pp. 114-121.
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abstract = "Background: We assessed the association between admission blood glucose levels and acute stroke mortality and examined if there was any incremental value of adding glucose status to the validated acute stroke mortality predictor - the SOAR score. Methods: Data from Norfolk and Norwich University Hospital Stroke & TIA register (20032013) and Anglia Stroke Clinical Network Evaluation Study (2009-2012) were analysed. Multivariable analysis assessed the association between admission blood glucose levels with inpatient and 7-day mortality. The prognostic ability of the SOAR score was then compared with the SOAR with glucose score(SOAR-G). Results: A total of 5,575 acute stroke patients(ischaemic stroke 89.2{\%}), with mean age(sd) of 76.97±11.88 years were included. Both borderline hyperglycaemia (7.9-11.0mmol/L) and hyperglycaemia (>11.0mmol/L) when compared to normoglycaemia (4.0-7.8mmol/L), were associated with both 7-day and inpatient mortality after controlling for sex, age, OCSP classification and pre-stroke modified Rankin score. Both the SOAR stroke score and SOAR G were good predictors of inpatient stroke mortality [AUC 0.82(95{\%}CI:0.81-0.84) and 0.83(95{\%}CI:0.81-0.84)], respectively. These scores were also good at predicting outcomes in both patients with and without diabetes. Conclusions: High blood glucose levels at admission were associated with worse acute stroke mortality outcomes. The constituents of the SOAR stroke score were good at predicting mortality after stroke.",
keywords = "Hyperglycaemia, Prognostic score, Stroke mortality",
author = "McCall, {Stephen J.} and Alanazi, {Turkiah A.} and Clark, {Allan B.} and Musgrave, {Stanley D.} and Bettencourt-Silva, {Joao H.} and Bachmann, {Max O.} and Metcalf, {Anthony K} and Bowles, {Kristian M.} and Mamas, {Mamas A.} and Potter, {John F.} and Myint, {Phyo K.}",
note = "Acknowledgements S.J.M. and T.A.A. are joint first authors. P.K.M. is the PI of both NNUSTR and ASCNES, and conceived the idea; S.D.M. and J.H.B-.S. performed data linkages; S.J.M. and T.A.A. did literature search, and cleaned and analysed the data under supervision of A.B.C.; J.F.P.D.M., M.O.B. and A.K.M. are co-I of ASCNES, and J.F.P.D.M., K.M.B. and A.K.M. are co-I of NNUSTR; and S.J.M. and P.K.M. drafted the manuscript. All authors contributed in writing the paper. P.K.M. is the guarantor. The authors gratefully acknowledge the data teams of the eight NHS Trusts which made up the ASCNES and the data team at the Norfolk and Norwich NHS Foundation Trust. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The authors would like to acknowledge the funders of the Anglia Stroke Clinical Network Evaluation Study (ASCNES) and the Norfolk and Norwich Stroke and TIA Register. ASCNES is funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme (PB-PG-1208-18240). This work presents independent research funded by the NIHR under its Research for Patient Benefit (RfPB) programme (grant reference no. PB-PG-1208-18240). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The NNUH stroke and TIA register is maintained by the NNUH NHS Foundation Trust Stroke Services, and data management for this study is supported by the NNUH Research and Development Department through Research Capability Funds.",
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T1 - Hyperglycaemia and the SOAR stroke score in predicting mortality

AU - McCall, Stephen J.

AU - Alanazi, Turkiah A.

AU - Clark, Allan B.

AU - Musgrave, Stanley D.

AU - Bettencourt-Silva, Joao H.

AU - Bachmann, Max O.

AU - Metcalf, Anthony K

AU - Bowles, Kristian M.

AU - Mamas, Mamas A.

AU - Potter, John F.

AU - Myint, Phyo K.

N1 - Acknowledgements S.J.M. and T.A.A. are joint first authors. P.K.M. is the PI of both NNUSTR and ASCNES, and conceived the idea; S.D.M. and J.H.B-.S. performed data linkages; S.J.M. and T.A.A. did literature search, and cleaned and analysed the data under supervision of A.B.C.; J.F.P.D.M., M.O.B. and A.K.M. are co-I of ASCNES, and J.F.P.D.M., K.M.B. and A.K.M. are co-I of NNUSTR; and S.J.M. and P.K.M. drafted the manuscript. All authors contributed in writing the paper. P.K.M. is the guarantor. The authors gratefully acknowledge the data teams of the eight NHS Trusts which made up the ASCNES and the data team at the Norfolk and Norwich NHS Foundation Trust. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The authors would like to acknowledge the funders of the Anglia Stroke Clinical Network Evaluation Study (ASCNES) and the Norfolk and Norwich Stroke and TIA Register. ASCNES is funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme (PB-PG-1208-18240). This work presents independent research funded by the NIHR under its Research for Patient Benefit (RfPB) programme (grant reference no. PB-PG-1208-18240). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The NNUH stroke and TIA register is maintained by the NNUH NHS Foundation Trust Stroke Services, and data management for this study is supported by the NNUH Research and Development Department through Research Capability Funds.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Background: We assessed the association between admission blood glucose levels and acute stroke mortality and examined if there was any incremental value of adding glucose status to the validated acute stroke mortality predictor - the SOAR score. Methods: Data from Norfolk and Norwich University Hospital Stroke & TIA register (20032013) and Anglia Stroke Clinical Network Evaluation Study (2009-2012) were analysed. Multivariable analysis assessed the association between admission blood glucose levels with inpatient and 7-day mortality. The prognostic ability of the SOAR score was then compared with the SOAR with glucose score(SOAR-G). Results: A total of 5,575 acute stroke patients(ischaemic stroke 89.2%), with mean age(sd) of 76.97±11.88 years were included. Both borderline hyperglycaemia (7.9-11.0mmol/L) and hyperglycaemia (>11.0mmol/L) when compared to normoglycaemia (4.0-7.8mmol/L), were associated with both 7-day and inpatient mortality after controlling for sex, age, OCSP classification and pre-stroke modified Rankin score. Both the SOAR stroke score and SOAR G were good predictors of inpatient stroke mortality [AUC 0.82(95%CI:0.81-0.84) and 0.83(95%CI:0.81-0.84)], respectively. These scores were also good at predicting outcomes in both patients with and without diabetes. Conclusions: High blood glucose levels at admission were associated with worse acute stroke mortality outcomes. The constituents of the SOAR stroke score were good at predicting mortality after stroke.

AB - Background: We assessed the association between admission blood glucose levels and acute stroke mortality and examined if there was any incremental value of adding glucose status to the validated acute stroke mortality predictor - the SOAR score. Methods: Data from Norfolk and Norwich University Hospital Stroke & TIA register (20032013) and Anglia Stroke Clinical Network Evaluation Study (2009-2012) were analysed. Multivariable analysis assessed the association between admission blood glucose levels with inpatient and 7-day mortality. The prognostic ability of the SOAR score was then compared with the SOAR with glucose score(SOAR-G). Results: A total of 5,575 acute stroke patients(ischaemic stroke 89.2%), with mean age(sd) of 76.97±11.88 years were included. Both borderline hyperglycaemia (7.9-11.0mmol/L) and hyperglycaemia (>11.0mmol/L) when compared to normoglycaemia (4.0-7.8mmol/L), were associated with both 7-day and inpatient mortality after controlling for sex, age, OCSP classification and pre-stroke modified Rankin score. Both the SOAR stroke score and SOAR G were good predictors of inpatient stroke mortality [AUC 0.82(95%CI:0.81-0.84) and 0.83(95%CI:0.81-0.84)], respectively. These scores were also good at predicting outcomes in both patients with and without diabetes. Conclusions: High blood glucose levels at admission were associated with worse acute stroke mortality outcomes. The constituents of the SOAR stroke score were good at predicting mortality after stroke.

KW - Hyperglycaemia

KW - Prognostic score

KW - Stroke mortality

U2 - 10.1177/1479164117743034

DO - 10.1177/1479164117743034

M3 - Article

VL - 15

SP - 114

EP - 121

JO - Diabetes and Vascular Disease Research

JF - Diabetes and Vascular Disease Research

SN - 1479-1461

IS - 2

ER -