{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T10:58:03Z","timestamp":1781348283040,"version":"3.54.1"},"reference-count":33,"publisher":"Walter de Gruyter GmbH","issue":"2","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The relationship of chronic hyperglycemia (CH) reflected by glycated hemoglobin A1c (HbA1c) with functional recovery in patients having acute ischemic stroke (AIS) remains controversial. This study evaluated how HbA1c values at admission could influence functional recovery following AIS of various etiologies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In total, 518 patients with AIS were included. Stroke etiology was determined by TOAST criteria. The modified Rankin Scale (mRS) was applied to evaluate the functional recovery. Independent-samples Mann\u2013Whitney U test was applied to assess the distribution of HbA1c across different subtypes. The relationship between HbA1c levels and functional recovery was analyzed applying multivariate logistic regression for adjustment of variables. Models predicting poor functional recovery, without and with HbA1c were developed utilizing binary logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>HbA1c levels were significantly elevated among patients with poor functional recovery (p &lt;0.001). The highest HbA1c values, median (IQR) [8.15(6.5\u201310.9)] were observed in patients with large artery atherosclerosis (LAA) subtype. Subgroup analyses by stroke subtype revealed significant associations of elevated HbA1c levels with poor functional recovery in the SVO (p = 0.021), LAA (p = 0.027), and cardio-embolic (CE), p = 0.046 groups. Elevated HbA1c remained independently associated with poor functional recovery (p = &lt;0.001; OR = 1.27; 95% CI = 1.12\u20131.45) after full adjustment for clinical variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Elevated admission HbA1c levels showed a fair to modest association with poorer functional recovery among patients with SVO, LAA, and CE stroke subtypes, which requires further external validation to establish its clinical implications and to consider HbA1c as an independent prognostic biomarker.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2478\/rjim-2026-0007","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T05:30:45Z","timestamp":1776749445000},"page":"105-115","source":"Crossref","is-referenced-by-count":0,"title":["The Prognostic Implication of Chronic Hyperglycemia in Acute Ischemic Strokes of Different Etiologic Subtypes"],"prefix":"10.2478","volume":"64","author":[{"given":"Azra","family":"Zafar","sequence":"first","affiliation":[{"name":"Department of Neurology, College of Medicine , Imam Abdulrahman Bin Faisal University , Dammam , Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Al Qarni","sequence":"additional","affiliation":[{"name":"Department of Neurology, College of Medicine , Imam Abdulrahman Bin Faisal University , Dammam , Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rizwana","family":"Shahid","sequence":"additional","affiliation":[{"name":"Department of Neurology, College of Medicine , Imam Abdulrahman Bin Faisal University , Dammam , Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Hafed","family":"Al Hashem","sequence":"additional","affiliation":[{"name":"Department of Neurology, College of Medicine , Imam Abdulrahman Bin Faisal University , Dammam , Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aishah","family":"Albakr","sequence":"additional","affiliation":[{"name":"Department of Neurology, College of Medicine , Imam Abdulrahman Bin Faisal University , Dammam , Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erum","family":"Shariff","sequence":"additional","affiliation":[{"name":"Department of Neurology, College of Medicine , Imam Abdulrahman Bin Faisal University , Dammam , Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaid","family":"Waqar","sequence":"additional","affiliation":[{"name":"Department of clinical neurosciences, College of Medicine , King Faisal University , Al-Ahsa , Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"2026061310340090172_j_rjim-2026-0007_ref_001","doi-asserted-by":"crossref","unstructured":"MITSOIS JP., EKINCI EI., MITSIOS GP., CHURILOV L., THIJS V. Relationship Between Glycated Hemoglobin and Stroke Risk: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2018 17; 7(11):e007858.","DOI":"10.1161\/JAHA.117.007858"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_002","doi-asserted-by":"crossref","unstructured":"ADAMS HP., BENDIXEN BH., KAPPELLE LJ., BILLER J., LOVE BB., GORDON DL., et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993; 24(1):35\u201341.","DOI":"10.1161\/01.STR.24.1.35"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_003","doi-asserted-by":"crossref","unstructured":"ZAFAR A., Al-KHAMIS FA., Al-BAKR AI., ALSULAIMAN AA., MSMAR AH. Risk factors and subtypes of acute ischemic stroke. A study at King Fahd Hospital of the University. Neurosciences (Riyadh). 2016; 21(3):246\u201351.","DOI":"10.17712\/nsj.2016.3.20150731"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_004","doi-asserted-by":"crossref","unstructured":"ROQUER J., GIRALT-STEINHAUER E., CERDA G., RODRIGUEZ-CAMPELLO A., CUADRADO-GODIA E., JIMENEZ CONDE J., et. al. Glycated hemoglobin value combined with initial glucose levels for evaluating mortality risk in patients with ischemic stroke. Cerebrovasc Dis 2015;40(5\u20136):244\u2013250","DOI":"10.1159\/000440735"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_005","doi-asserted-by":"crossref","unstructured":"BAO Y and GU D. Glycated hemoglobin as a marker for predicting outcomes of patients with stroke (Ischemic and Hemorrhagic): A systematic review and meta-Analysis. Front. Neurol. 2021; 12:642899.","DOI":"10.3389\/fneur.2021.642899"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_006","doi-asserted-by":"crossref","unstructured":"ALHAWITI NM., ELSOKKARY E.M., ALDALI JA., ALOTAIBI BA. Investigating the impact of glycated hemoglobin levels on stroke severity in patients with acute ischemic stroke. Sci Rep. 2025; 15(1):12114.","DOI":"10.1038\/s41598-025-95305-2"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_007","doi-asserted-by":"crossref","unstructured":"DONG N., SHEN X., WU X., GUO X., FANG Q. Elevated glycated hemoglobin levels are associated with poor outcome in acute ischemic stroke. Front Aging Neurosci. 2021; 13:821336.","DOI":"10.3389\/fnagi.2021.821336"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_008","doi-asserted-by":"crossref","unstructured":"RINKEL LA., NGUYEN TTM., GUGLIELMI V., GROOT AE., POSTHUMA L., ROOS YBWEM., et al. High admission glucose is associated with poor outcome after endovascular treatment for ischemic stroke. Stroke. 2020;51(11):3215\u20133223.","DOI":"10.1161\/STROKEAHA.120.029944"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_009","doi-asserted-by":"crossref","unstructured":"GAO F., TAN X., LI L., ZHOU C., GUO C., YANG J., et al. Association of Admission HbA1c Levels and Clinical Outcomes in Patients with Large Vessel Occlusion Following Endovascular Treatment: A Secondary Analysis of RESCUE BT Trial. Clin Interv Aging. 2025; 20:727\u2013737.","DOI":"10.2147\/CIA.S523638"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_010","doi-asserted-by":"crossref","unstructured":"KAMOUCHI M., MATSUKI T., HATA J., KUWASHIRO T., AGO T, SAMBONGI Y., et al. Prestroke glycemic control is associated with functional outcome in acute ischemic stroke. Stroke. 2011;42(10):2788\u20132794.","DOI":"10.1161\/STROKEAHA.111.617415"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_011","doi-asserted-by":"crossref","unstructured":"GAO Y., JIANG L., WANG H., YU C., WANG W., LIU S., et al. Association between elevated hemoglobin A1c levels and the outcomes of patients with small artery occlusion: a hospital-based study. PLoS ONE. 2016; 11:e0160223.","DOI":"10.1371\/journal.pone.0160223"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_012","doi-asserted-by":"crossref","unstructured":"WANG H., CHENG Y., CHEN S., LI X., ZHU Z., Zang W. Impact of elevated hemoglobin A1c levels on functional outcome in patients with acute ischemic stroke. J Stroke Cerebrovasc Dis. 2019; 28(2): 470\u2013476.","DOI":"10.1016\/j.jstrokecerebrovasdis.2018.10.026"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_013","doi-asserted-by":"crossref","unstructured":"JEONG J., PARK JK., KOH YH., PARK JM., BAE HJ., YUN SM. Association of HbA1c with functional outcome by ischemic stroke subtypes and age. Front Neurol. 2023; 14:1247693.","DOI":"10.3389\/fneur.2023.1247693"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_014","doi-asserted-by":"crossref","unstructured":"CAO C., WANG TB., HU H., HAN Y., ZHANG X., WANG Y., et al. Relationship between glycated hemoglobin levels and three-month outcomes in acute ischemic stroke patients with or without diabetes: a prospective Korean cohort study. BMC Neurol. 2024; 24(1): 85.","DOI":"10.1186\/s12883-024-03581-8"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_015","doi-asserted-by":"crossref","unstructured":"ZAFAR A., ALBAKR A., SHAHID R., ALKHAMIS F., ALABDALI M., ALJAAFARI D., et al. Association between glycated hemoglobin and functional outcomes in patients with intracranial large artery atherosclerotic disease-related acute ischemic stroke: identifying the magic number. Front Neurol. 2023; 14:1249535.","DOI":"10.3389\/fneur.2023.1249535"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_016","doi-asserted-by":"crossref","unstructured":"ALFAKEEH FK., ALGHAMDI YM., ALHARBI BF., ALOTAIBI AM., ALSALEH KA., ALSHUBAILI AM., et al. HbA1c and risk factors' prevalence in patients with stroke: a retrospective study in a tertiary care hospital in Saudi Arabia. Neurosciences (Riyadh). 2024; 29(1):18\u201324.","DOI":"10.17712\/nsj.2024.1.20230037"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_017","doi-asserted-by":"crossref","unstructured":"Stroke\u22121989: Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO task force on stroke and other cerebrovascular disorders. Stroke. 1989; 20(10):1407\u201331.","DOI":"10.1161\/01.STR.20.10.1407"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_018","doi-asserted-by":"crossref","unstructured":"VAN SWIETEN JC., KOUDSTAAL PJ., VISSER MC., SCHOUTEN HJ., VAN GIJN J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988; 19(5): 604\u20137.","DOI":"10.1161\/01.STR.19.5.604"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_019","doi-asserted-by":"crossref","unstructured":"QIU X., XUE X., XU R., WANG J., ZHANG L., ZHANG L., et al. Predictors, causes and outcome of 30-day readmission among acute ischemic stroke. Neurol Res. 2021;43(1):9\u201314..","DOI":"10.1080\/01616412.2020.1815954"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_020","doi-asserted-by":"crossref","unstructured":"TORRES-AGUILA NP., CARRERA C., MUINO E., CULLELL N., CARCEL-MARQUEZ J., GALLEGO-FABREGA C, et al. Clinical variables and genetic risk factors associated with the acute outcome of ischemic stroke: a systematic review. J Stroke. 2019; 21(3):276.","DOI":"10.5853\/jos.2019.01522"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_021","doi-asserted-by":"crossref","unstructured":"WEIMAR C., ZIEGLER A., KONIG IR, DIENER HC. Predicting functional outcome and survival after acute ischemic stroke. J Neurol. 2002; 249(7):888\u201395.","DOI":"10.1007\/s00415-002-0755-8"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_022","doi-asserted-by":"crossref","unstructured":"MURAT SUMER M., ERTURK O. Ischemic stroke subtypes: risk factors, functional outcome and recurrence. Neurol Sci. 2002; 22(6):449\u201354.","DOI":"10.1007\/s100720200004"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_023","doi-asserted-by":"crossref","unstructured":"JEONG J., PARK JK., KOH YH., PARK JM., BAE HJ., YUN SM. Association of HbA1c with functional outcome by ischemic stroke subtypes and age. Front Neurol. 2023; 14:1247693.","DOI":"10.3389\/fneur.2023.1247693"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_024","doi-asserted-by":"crossref","unstructured":"MIEDEMA I., LUIJCKX GJ., BROUNS R., DE KEYSER J., UYTTENBOOGAART M. Admission hyperglycemia and outcome after intravenous thrombolysis: is there a difference among the stroke-subtypes? BMC Neurol. 2016; 16:104.","DOI":"10.1186\/s12883-016-0617-0"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_025","doi-asserted-by":"crossref","unstructured":"LEI C., WU B., LIU M., CHEN Y. Association between hemoglobin A1C levels and clinical outcome in ischemic stroke patients with or without diabetes. Journal of Clinical Neuroscience. 2015; 22(3):498\u2013503.","DOI":"10.1016\/j.jocn.2014.08.030"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_026","doi-asserted-by":"crossref","unstructured":"SUNAGA K., MIURA K., NARUSE Y., SAKURAI M., MORIKAWA Y., KUROSAW Y, et al. Glycated hemoglobin and risk of stroke, ischemic and hemorrhagic, in Japanese men and women. Cerebrovasc Dis. 2008; 26(3):310\u20136.","DOI":"10.1159\/000149579"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_027","doi-asserted-by":"crossref","unstructured":"MARINI MA., FIORENTINO TV., ANDREOZZI F., MANNINO GC., SUCCURRO E, SCIACQUA A., et al. Hemorheological alterations in adults with prediabetes identified by hemoglobin A1c levels. Nutrition, Metabolism and Cardiovasc Dis. 2017; 27(7):601\u20138.","DOI":"10.1016\/j.numecd.2017.04.001"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_028","doi-asserted-by":"crossref","unstructured":"LI Q, YANG LZ. Hemoglobin A1c level higher than 9.05% causes a significant impairment of erythrocyte deformability in diabetes mellitus. Acta Endocrinol (Bucharest). 2018; 14(1):66.","DOI":"10.4183\/aeb.2018.66"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_029","doi-asserted-by":"crossref","unstructured":"SONG SH., KIM JH., LEE JH., YUN YM., CHOI DH., KIM HY. Elevated blood viscosity is associated with cerebral small vessel disease in patients with acute ischemic stroke. BMC Neurol. 2017; 17(1):20.","DOI":"10.1186\/s12883-017-0808-3"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_030","doi-asserted-by":"crossref","unstructured":"DAWSON J., BEJOT Y., CHRISTENSEN LM., DE MARCHIS GM, DICHGANS M., HAGBERG G et al. European stroke organisation (ESO) guideline on pharmacological interventions for long-term secondary prevention after ischaemic stroke or transient ischaemic attack. Eur Stroke J. 2022; 7(3):I\u2013II.","DOI":"10.1177\/23969873221100032"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_031","doi-asserted-by":"crossref","unstructured":"MAHFOUZ AA., ABDELMONEIM SA., ABDU SMM., SHIBA HAA., ABOELELA AM., GHAZY RM, et al. Understanding the stroke burden in Saudi Arabia: Trends from 1990 to 2019 and forecasting through time series analysis. Neurosciences (Riyadh). 2025;30(1):49\u201358.","DOI":"10.17712\/nsj.2025.1.20240092"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_032","doi-asserted-by":"crossref","unstructured":"ALJAFEN BN., MEO AS., SHAIKH N, MEA SA. Stroke incidence, mortality and disability-adjusted life years (DALYs) trends in association with air pollution, dietary and metabolic risk factors in Gulf Cooperation Council countries: Global burden of disease data based analysis 1990\u20132021. Saudi Med J. 2025;46(10):1191\u20131201.","DOI":"10.15537\/smj.2025.46.10.20250407"},{"key":"2026061310340090172_j_rjim-2026-0007_ref_033","doi-asserted-by":"crossref","unstructured":"ALMUTAIRI JS., ALMIGBAL TH., ALRUHAIM HY., MUJAMMAMI MH., ALMOGBEL TA., ALSHAHRANI AM., et al. Self-awareness of HbA1c and its association with glycemic control among patients with type 2 diabetes: A multicenter study. Saudi Med J. 2022;43(3):291\u2013300.","DOI":"10.15537\/smj.2022.43.3.20210536"}],"container-title":["Romanian Journal of Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/reference-global.com\/pdf\/10.2478\/rjim-2026-0007","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T10:36:20Z","timestamp":1781346980000},"score":1,"resource":{"primary":{"URL":"https:\/\/reference-global.com\/article\/10.2478\/rjim-2026-0007"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,16]]},"references-count":33,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,4,16]]},"published-print":{"date-parts":[[2026,6,1]]}},"alternative-id":["10.2478\/rjim-2026-0007"],"URL":"https:\/\/doi.org\/10.2478\/rjim-2026-0007","relation":{},"ISSN":["2501-062X"],"issn-type":[{"value":"2501-062X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,16]]}}}