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Is on-admission capillary blood beta-hydroxybutyrate concentration associated with the acute stroke severity and short-term functional outcome?

Abstract Objectives: In conditions with reduced glucose levels/inability of glucose utilization, ketone bodies, especially beta-hydroxybutyrate (BHB), become a major energy source in the brain. In animal models, BHB infusion shows acute beneficial effects on the hypoxic brain. The present prospective observational study is the first to assess the relationship between on-admission capillary blood BHB levels and acute stroke severity/short-term functional outcomes. Methods: A total of 51 consecutive first-ever stroke patients (46 ischemic stroke) admitted within 24 hours since the symptom onset and ≤44 hours since the last meal were evaluated for stroke severity (National institutes of health stroke scale, NIHSS) and for disability (modified Rankin scale, mRS) 3 months post-stroke. Results: On-admission BHB values ranged between 0 and 1·6 mmol/l, with 43 (84·3%) values ≤0·4 mmol/l (normal). Higher BHB values were independently associated with longer fasting and hyperglycemia, whereas lower values were associated with dyslipidemia and diabetes. No association between on-admission BHB levels and NIHSS scores at presentation or day 5 was observed. The BHB levels considered either as continuous or as binary (>0·4 vs ≤0·4 mmol/l) variables were independently (adjustment for age, NIHSS score at presentation, fasting period, stroke type, hyperglycemia, diabetes, and dyslipidemia) associated with lower odds of mRS 0–2 (non-to-mild disability) 3 months post-stroke: OR  =  0·09 (95% CI 0·00–0·97, P  =  0·047) and OR  =  0·07 (95% CI 0·00–0·78, P  =  0·028), respectively. Discussion: This preliminary study suggests that higher on-admission BHB values are associated with poorer stroke outcomes and emphasizes the need for further investigations.