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Predictive Value of Glycosylated Hemoglobin Level on the Secondary Cerebrovascular Event of Diabetic Patients with Ischemic Stroke

SUN Qiang;SUN Yan-peng;WANG Yun-fu;Department of Neurology, Taihe Hospital, Hubei Medical College;  
Objective:To observe the predictive value of glycosylated hemoglobin(HbA1c) level on the secondary cerebrovascular events(SCE) of diabetic patients with ischemic stroke. Methods: From June 2008 to June 2011, 168 diabetic patients with ischemic stroke were admitted. The patients were divided into elevated HbA1c group(HbA1c≥6.1%) and normal HbA1c group(HbA1c6.1%). All the patients have been followed up every two month and the occurrence of SCE was documented in 18 months. According to the follow-up data, the patients were assigned into the event and non-event groups. The power of HbA1c levels to predict SCE was examined by receiver operating characteristic(ROC) curve. Results: When compared with the normal HbA1c group(n=75), the fasting blood glucose, postprandial blood glucose, systolic pressure, cholesterol, triglyceride and low density lipoprotein cholesterol were significantly increased, while high density lipoprotein cholesterol and Barthel index were significantly decreased in elevated HbA1c group(n=93)(all P0.01). At the endpoint, there were 49 and 119 patients in the event group and non-event group respectively. When compared with the non-event group, the HbA1c level was higher in the event group [(6.96±2.40)% vs.(9.57±1.93)%, P0.01). The area under the ROC curve(AUC) of HbA1c level to predict the SCE was 0.784(P0.01, 95%CI 0.713~0.855). The cut-off value of HbA1c was 6.55%, with a sensitivity of 86.80% and a specificity of 64.30%. The Kaplan-Meier survival curve showed that the occurrence of SCE was increased in the patients with HbA1c level ≥6.55%. Conclusion: The elevated HbA1c level may be a significant predictor for SCE in diabetic patients with ischemic stroke in 18 months.
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