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Glycemia and clinical outcome after a stroke: what is the link?

​With the help of metabolomics, a study by the CEA-Joliot and its partners has improved the understanding of the complex relationship between blood glucose levels (glycemia) and the functional outcome of patients following a stroke.

Published on 10 March 2021

According to Santé Publique France, more than 140,000 people suffer a stroke in France each year. For 30% the incident is fatal within a year of the stroke and almost 70% suffer permanently from various after-effects. Treatment consists in rapidly restoring blood flow in the occluded artery by removing the clot (thrombus) mechanically or enzymatically as soon as hospital care can be provided. Mechanical thrombectomy is performed by neuroradiologists while at the same time, neurovascular physicians apply intravenous thrombolysis with alteplase. However, despite arterial disocclusion half of the patients never regain full autonomy. A strategy that provides neuroprotection of the brain tissue from irreversible damage remain to be developed.

Many scientists are currently focusing on the potential role of blood glucose levels in neuroprotection during stroke. Despite successful thrombectomy, hyperglycemia on hospital admission of a stroke patient is associated with poor functional outcome. However, clinical studies showed that insulin targeting of hyperglycemia on admission do not provide significant clinical benefit. So, what is the real relationship between blood glucose level and the functional outcome of stroke patients? To further address this question and to gain information about the blood glucose levels at stroke onset, researchers from the CEA-Joliot, in collaboration with neurovascular clinicians from the university hospitals of Nice and Marseille, analyzed the metabolome of blood cells that were entrapped in the retrieved clots at stroke onset. Artificial intelligence (AI), in particular machine learning, was used to identify a metabolomic signature associated with a functional outcome of the patient. The researchers showed that hyperglycemia at the moment of stroke onset has a neuroprotective effect and reduces the risk of after-effects.

The study shows the beneficial effect of glucose during the initial phase of a stroke. Although this result still needs to be confirmed by more larger clinical studies, it underlines the importance of targeting neuroprotection immediately after stroke onset, i.e. before hospital care can be provide.

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