RESUMEN
Objective: This study aimed to investigate the effect of the glycated hemoglobin A1c (HbA1c) level on the functional outcome (FOC) in patients with intracranial large artery atherosclerotic disease (ICLAD)-related acute ischemic stroke (AIS). Methods: This retrospective study enrolled patients with ICLAD-related AIS who were admitted to King Fahd University Hospital between January 2017 and September 2021. Patients were divided into two groups based on the optimal cutoff HbA1c level determined using receiver operating characteristic curve analysis-those with HbA1c ≤6.9% and those with HbA1c >6.9%. Demographic and other clinical characteristics were compared between the two groups using chi-square tests. The association between HbA1c and 90-day FOC was assessed using the chi-square test and odds ratios (ORs). Multivariate analysis was performed to adjust for confounding factors. Results: A total of 140 patients were included in the analysis. A significant association was observed between the HbA1c level and FOC. Compared to patients with HbA1c ≤6.9%, patients with HbA1c >6.9% were more likely to have an unfavorable FOC [p = <0.001, OR = 2.05, 95% confidence interval (CI) = 1.33-3.14]. The association between HbA1c >6.9% and unfavorable FOC was sustained even after adjusting for confounding factors (p = 0.008) and atherosclerosis risk factors (p = 0.01). HbA1c >6.9% was also associated with higher ORs for in-hospital complications (p = 0.06, OR = 1.34, 95% CI = 1.02-1.77) and mortality (p = 0.07, OR = 1.42, 95% CI = 1.06-1.92) although these associations did not attain significant p-values. Conclusion: HbA1c >6.9% was significantly associated with unfavorable FOC in ICLAD-related AIS. However, further studies with larger sample sizes are required to verify whether HbA1c is an independent predictor of poor FOC. Nevertheless, targeting HbA1c <7% should be the goal of physicians when managing patients at high risk of ICLAD.
RESUMEN
BACKGROUND: No evidence of disease activity (NEDA) is a composite surrogate assessing the responsiveness to various disease-modifying treatments (DMTs) in patients with relapsing and remitting multiple sclerosis (RRMS), addressing clinical as well as radiological disease activity. Despite the rising prevalence of multiple sclerosis in Saudi Arabia (SA), there is a lack of evidence focusing on this important aspect in the management of RRMS. This study aimed to identify the prevalence of NEDA-3 status achievement in patients with RRMS on DMTs (mainly the interferon) and to describe the factors affecting its attainment. METHOD: This was a retrospective, cross-sectional study carried out at King Fahd University Hospital after obtaining institutional ethical approval. The electronic records of 119 patients diagnosed with RRMS were reviewed. Clinical manifestations at initial presentation, relapse after starting treatment, disability progression, and development of new lesions on follow-up magnetic resonance imaging were all documented to assess NEDA-3 status. Data were analyzed using Statistical Package for Social Sciences, version 22. RESULTS: NEDA-3 status was achieved in 41 (33.6%) patients. The female-to-male ratio for all patients was 1.5:1. Interferon (IFN) was the most commonly prescribed DMT. NEDA-3 status was achieved in 30.9% of patients receiving IFN. Mean baseline Expanded Disability Status Scale in patients who did not achieve NEDA-3 was 2.8±1.8. Patients with ataxia (P = <0.001), sphincter disturbances (P=0.002) and infra-tentorial brain lesions (P=0.03) were less likely to achieve NEDA-3 status. Involvement of pyramidal, cerebellar and more than one system at initial presentation was more frequent in patients who could not achieve NEDA-3 status (P=0.002) CONCLUSION: Less than one third of total patients on IFN as DMT could achieve NEDA-3 status in our cohort of patients which is in agreement with the literature published in the West. We could not properly asses NEDA-3 status for other DMTs in our center due to the very small sample size of patients on these DMTs, and recommend future studies including larger number of patients on DMTs other than IFN. Significant differences were identified between the two groups of patients with respect to attainment of NEDA-3 status, which requires further verification by multicenter prospective studies.
