Background

Hyperglycemia is common after acute ischemic stroke and is associated with worse outcome, but intensive glucose control has not improved outcome. There is also a racial disparity in outcome after stroke, with Black patients more likely to have functional impairment than whites. We aimed to evaluate if there were racial differences in outcomes in acute ischemic stroke patients treated with intensive glucose control.

Methods

We performed a post-hoc analysis of the Stroke Hyperglycemia Insulin Network Effort (SHINE) trial to determine if Black patients had worse functional outcome than whites and if standard versus intensive glucose control modified that association. We included non-Hispanic white and Black patients. The primary outcome was excellent functional outcome (90-day modified Rankin Score of 0-1). To account for patient clustering by study site, we fit mixed-effects logistic regression models to our outcome and tested the interaction of treatment and race.

Results

We included 895 patients, of which 304 (34%) were Black and 591 (66%) were white. The rate of excellent outcome was 31.6% in Black patients versus 41.0% in white patients (p=0.006). After adjusting for potential confounders, the odds ratio for excellent outcome in Black patients was 0.54 (95% CI 0.38-0.77). The interaction term between treatment and race was significant (p=0.067). In the intensive treatment arm, Black patients had a predicted probability of excellent outcome of 26.4% (20.1-32.8) versus 42.7% (37.6-47.9) for white patients (p<0.001), while in the standard treatment arm the difference was not significant.

Conclusions

Black patients with acute ischemic stroke and hyperglycemia had worse functional outcome at 90 days than white patients, particularly if given intensive glucose control. These findings are from a post-hoc analysis and may be confounded, thus warrant additional study.

中文翻译：

---

如果给予强化葡萄糖控制，患有缺血性中风和高血糖的黑人患者的结果比白人更差

背景

急性缺血性卒中后高血糖很常见，并且与更差的结果相关，但强化血糖控制并没有改善结果。中风后的结果也存在种族差异，黑人患者比白人更容易出现功能障碍。我们旨在评估接受强化血糖控制治疗的急性缺血性卒中患者的结局是否存在种族差异。

方法

我们对中风高血糖胰岛素网络努力 (SHINE) 试验进行了事后分析，以确定黑人患者的功能结果是否比白人更差，以及标准与强化血糖控制是否改变了这种关联。我们纳入了非西班牙裔白人和黑人患者。主要结果是出色的功能结果（90 天改良 Rankin 评分为 0-1）。为了解释研究地点的患者聚类，我们将混合效应逻辑回归模型拟合到我们的结果中，并测试了治疗和种族的相互作用。

结果

我们纳入了 895 名患者，其中 304 (34%) 名黑人和 591 (66%) 名白人。黑人患者的优良结果率为 31.6%，白人患者为 41.0% (p=0.006)。在对潜在混杂因素进行调整后，黑人患者获得优异结果的比值比为 0.54（95% CI 0.38-0.77）。治疗和种族之间的交互项是显着的（p=0.067）。在强化治疗组中，黑人患者的优异结果预测概率为 26.4% (20.1-32.8)，白人患者为 42.7% (37.6-47.9)（p<0.001），而在标准治疗组中，差异不显着重大。

结论

患有急性缺血性中风和高血糖的黑人患者在 90 天时的功能结果比白人患者更差，特别是如果给予强化血糖控制的话。这些发现来自事后分析，可能会混淆，因此需要进一步研究。