ABSTRACT NUMBER: ESOC2026A2466 IMPAIRED GLUCOSE HOMEOSTASIS IN FRAILTY AND OUTCOMES FOLLOWING MECHANICAL THROMBECTOMY

Abstract Background and aims Frailty – the loss of physiological reserve after a stressor event – is associated with poorer outcomes after stroke, but the most sensitive blood-based predictors remain unclear. This study evaluates different measures of physiological homeostasis regulation (glucose, sodium, and calcium levels) and whether they may serve as a proxy for frailty and predicting mortality following mechanical thrombectomy. Methods We retrospectively analysed 248 patients treated with mechanical thrombectomy at Addenbrooke’s Hospital between 2023 and 2024. Admission glucose was measured as a continuous variable and as a dichotomised value (at a 11.1mmol/L cut-off) at the time of the procedure. Sodium concentration and ionised calcium were also collected within six hours of procedure. Frailty was assessed using a validated frailty index (FI). Stroke severity (NIHSS) and the presence of diabetes was also collected. The primary outcome was 30-day survival post-thrombectomy. Results On univariable analysis, there was a weak but significant association between FI and glucose (rs=0.17, p=0.03), but not sodium (rs=-0.05, p=0.49) or calcium (rs=-0.07, p=0.36). On multivariable analysis (adjusting for NIHSS, FI, and diabetes), elevated glucose levels (above 11.1mmol/L) remained independently associated with 30-day mortality after thrombectomy (aOR 1.28, 95% CI 1.02-1.61). Conclusions The exact mechanisms by which frailty exerts disease- and treatment-modifying effects remains uncertain, but the loss of physiological regulation of glucose – independent of the presence of diabetes – may provide important mechanistic insights, inform prognostication, and yield potential therapeutic strategies to mitigate the effects of frailty in hyperacute stroke. Conflict of interest EG: Nothing to disclose. NE: Grant support from the Stroke Association.