Abstract 37: Acute Hyperglycemia At Stroke Onset Is Associated With Abnormal Red Blood Cells

Background: Acute hyperglycemia at stroke onset is a common clinical problem and is an independent predictor of mortality and long-term disability. Abnormal red blood cells (RBCs) have long been recognized as a stroke risk factor and are associated with poor stroke outcome. Recent evidence has shown that short term hyperglycemia exposure can intensify oxidative stress in RBCs and cause hemolysis. We hypothesize that acute hyperglycemia may induce RBC dysfunction in stroke patients, which may be related to the poor outcome in those patients. Method: 93 stroke patients were consecutively recruited in accordance with IRB protocol. Patients with diabetes, prediabetes or HbA1C ≥ 5.7% were excluded. None of the patients had preexisting anemia. Hyperglycemia was defined as blood glucose > 110 mg/dL at admission. RBC indices were documented for all the patients. Patients with major hemorrhagic events and multiple blood draws were excluded from the study. Clinical outcome was determined by mRankin Scale at 3 month (good: ≤ 2; poor: > 2). Result: 45 (48.4%) were hyperglycemic and 48 (51.6%) were normoglycemic. Hyperglycemic patients showed gradually decreased RBC counts and hemoglobin content, while RBC distribution width (RDW) was gradually elevated (Fig. A). Subgroup analyses showed that the association of hyperglycemia with RBC alterations was not affected by sex and age, two factors that are known to affect RBC function (Fig. B). More importantly, patients with abnormally low RBC count, low hemoglobin and high RDW were at increased risk of developing poor outcome (Fig. C). These results remained robust after adjusting for other risk factors (Fig. C), suggesting that abnormal RBC parameters are independent predictors of poor stroke outcome. Conclusion: Our results revealed that acute hyperglycemia at stroke onset is associated with abnormal RBC indices, which are predictive of poor stroke outcome. Studies in a larger patient cohort with extended time course are still ongoing.