Glucose-6-phosphate dehydrogenase deficiency and stroke outcomes

Objective: To ascertain whether G6PD deficiency affects outcomes at 3 months after stroke, we recruited 1251 patients with acute ischemic stroke and detected erythrocyte-G6PD activity.

Methods: The prospective study participants consisted of 1,251 patients with ischemic stroke within 2 weeks of onset from four clinical centers in South China. Patients were individually categorized into the G6PD-deficiency group and non-G6PD-deficiency group according to erythrocyte-G6PD activity upon admission. Baseline characteristics and clinical outcomes (modified Rankin Scale score [mRS], poor functional outcome [mRS ≥ 2] at 3 months, and death) were compared between the two groups. The associations of G6PD deficiency with outcomes were evaluated using Cox proportional hazards and logistic regression analyses.

Results: Among 1251 patients, 150 (12.0 %) were G6PD deficient; patients with G6PD deficiency had higher proportions of large-artery atherosclerosis (56.7% vs. 46.0% in non-G6PD-deficiency; odds ratio [OR] 1.53, 95% confidence interval [CI] 1.09-2.17) and stroke history (23.3% vs. 13.6% in non-G6PD-deficiency; OR 1.93, 95% CI 1.26-2.90). Multivariable logistic regression analysis showed the G6PD-deficiency and non-G6PD-deficiency group differed significantly in their overall distribution of mRS scores (adjusted common OR 1.57, 95% CI 1.14-2.17). Patients with G6PD deficiency had higher rates of poor functional outcome at 3 months (61.9% vs. 50.0% in non-G6PD-deficiency; adjusted OR 1.73, 95% CI 1.08-2.76). The hazard ratio of in-hospital death for patients with G6PD-deficiency was 1.46 (95% CI 1.37-1.84).

Conclusions: G6PD deficiency is associated with the risk of poor functional outcome at 3 months after ischemic stroke, and may increase the risk of in-hospital death.