Abstract
Background: Impaired glucose tolerance (IGT) in patients with ischemic stroke can return to normal,
reflecting an acute stress response, or persist. Persistent IGT is associated with
an increased risk of recurrent stroke, other cardiovascular diseases and unfavorable
outcome after stroke. We aim to validate our previously developed model to identify
patients at risk of persistent IGT in an independent data set, and, if necessary,
update the model. Methods: The validation data set consisted of 239 nondiabetic patients with a minor ischemic
stroke or TIA and IGT in the acute phase (2-hour post-load glucose levels between
7.8 and 11.0 mmol/l). The outcome was persistent versus normalized IGT, based on repeated
oral glucose tolerance test after a median of 46 days. The discriminative ability
of the original model was assessed with the area under the ROC curve (AUC). The updated
model was internally validated with bootstrap resampling and cross-validated in the
development population of the original model. Results: One-hundred eighteen of 239 (49%) patients had persistent IGT. The original model,
with the predictors age, current smoking, statin use, triglyceride, hypertension,
history of cardiovascular diseases, body mass index (BMI), fasting plasma glucose
performed poorly (AUC .60). The newly developed model included only BMI, hypertension,
statin use, atrial fibrillation, 2-hour post-load glucose levels, HbA1c, large artery
atherosclerosis, and predicted persistent IGT more accurately (internally validated
AUC 0.66, externally validated AUC .71). Conclusions: This prediction model with simple clinical variables can be used to predict persistent
IGT in patients with IGT directly after minor stroke or TIA, and may be useful to
optimize secondary prevention by early identification of patients with disturbed glucose
metabolism.
Key Words
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Article info
Publication history
Published online: April 14, 2020
Accepted:
March 13,
2020
Received in revised form:
March 7,
2020
Received:
February 14,
2020
Footnotes
Grant Support: None.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104815
Copyright
© 2020 Elsevier Inc. All rights reserved.
