ABSTRACT NUMBER: ESOC2026A2280 ASSOCIATION BETWEEN ELEVATED HBA1C LEVELS AND FUNCTIONAL OUTCOME IN ACUTE ISCHEMIC STROKE: AN EXPLORATORY META-ANALYSIS

Abstract Background and aims Elevated glycated hemoglobin (HbA1c) has been associated with worse outcomes after acute ischemic stroke (AIS); however, its prognostic role remains inconsistent across studies and is not routinely integrated into clinical decision-making. The objective is to evaluate the association between elevated admission HbA1c levels and poor functional outcome (modified Rankin Scale [mRS] >2) in patients with AIS through an exploratory meta-analysis, and to describe additional clinically relevant outcomes using narrative synthesis. Methods A systematic search of PubMed, Scopus, and Embase was performed without language restrictions, prioritizing studies published within the last five years. Of 132 records identified, 10 studies underwent full-text review. Six studies met inclusion criteria. Four studies (n = 8,448 patients) reporting functional outcome using the mRS were included in the quantitative analysis. Two additional studies contributed narrative data on mortality, NIHSS score, and stroke recurrence. A random-effects model was applied. Results Elevated HbA1c levels (≥6.5% or ≥7%, depending on study definition) were associated with a higher likelihood of poor functional outcome (pooled OR 1.38; 95% CI 1.15–1.67), with low heterogeneity (I2 = 22.7%, τ2 = 0.089). In narrative analyses, elevated HbA1c was associated with higher mortality, greater stroke severity at admission (higher NIHSS), and increased recurrence rates. Conclusions Elevated admission HbA1c is associated with worse functional outcomes and other adverse clinical endpoints in AIS. HbA1c may serve as a complementary prognostic marker and warrants further evaluation in prospective studies. Conflict of interest Nothing to disclose