Persistent hyperglycemia at 24-48 h in acute hyperglycemic stroke patients is not associated with a worse functional outcome.

Details

Serval ID
serval:BIB_A6EA0054E072
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Persistent hyperglycemia at 24-48 h in acute hyperglycemic stroke patients is not associated with a worse functional outcome.
Journal
Cerebrovascular Diseases
Author(s)
Ntaios G., Abatzi C., Alexandrou M., Lambrou D., Chatzopoulos S., Egli M., Ruiz J., Bornstein N., Michel P.
ISSN
1421-9786 (Electronic)
ISSN-L
1015-9770
Publication state
Published
Issued date
2011
Volume
32
Number
6
Pages
561-566
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov'tPublication Status: ppublish
Abstract
BACKGROUND: Recently, it was shown that the relation between admission glucose and functional outcome after ischemic stroke is described by a J-shaped curve, with a glucose range of 3.7-7.3 mmol/l associated with a favorable outcome. We tested the hypothesis that persistence of hyperglycemia above this threshold at 24-48 h after stroke onset impairs 3-month functional outcome.
METHODS: We analyzed all patients with glucose >7.3 mmol/l on admission from the Acute STroke Registry and Analysis of Lausanne (ASTRAL). Patients were divided into two groups according to their subacute glucose level at 24-48 h after last well-being time (group 1: ≤7.3 mmol/l, group 2: >7.3 mmol/l). A favorable functional outcome was defined as a modified Rankin Score (mRS) ≤2 at 3 months. A multiple logistic regression analysis of multiple demographic, clinical, laboratory and neuroimaging covariates was performed to assess predictors of an unfavorable outcome.
RESULTS: A total of 1,984 patients with ischemic stroke were admitted between January 1, 2003 and October 20, 2009, within 24 h after last well-being time. In the 421 patients (21.2%) with admission glucose >7.3 mmol/l, the proportion of patients with a favorable outcome was not statistically significantly different between the two groups (59.2 vs. 48.7%, respectively). In multiple logistic regression analysis, unfavorable outcome was significantly associated with age (odds ratio, OR: 1.06, 95% confidence interval, 95% CI: 1.03-1.08 for every 10-year increase), National Institute of Health Stroke Score, NIHSS score, on admission (OR: 1.16, 95% CI: 1.11-1.21), prehospital mRS (OR: 12.63, 95% CI: 2.61-61.10 for patients with score >0), antidiabetic drug usage (OR: 0.36, 95% CI: 0.15-0.86) and glucose on admission (OR: 1.16, 95% CI: 1.02-1.31 for every 1 mmol/l increase). No association was found between persistent hyperglycemia at 24-28 h and outcome in either diabetics or nondiabetics.
CONCLUSIONS: In ischemic stroke patients with acute hyperglycemia, persistent hyperglycemia (>7.3 mmol/l) at 24-48 h after stroke onset is not associated with a worse functional outcome at 3 months whether the patient was previously diabetic or not.
Keywords
Aged, Blood Glucose/metabolism, Brain Ischemia/complications, Confidence Intervals, Diabetes Complications/therapy, Emergency Medical Services, Female, Humans, Hyperglycemia/complications, Hyperglycemia/therapy, Hypoglycemic Agents/therapeutic use, Intracranial Embolism/complications, Intracranial Embolism/therapy, Logistic Models, Male, Middle Aged, Odds Ratio, Registries, Stroke/complications, Stroke/etiology, Stroke, Lacunar/complications, Stroke, Lacunar/therapy, Thrombolytic Therapy, Tomography, X-Ray Computed, Treatment Outcome
Pubmed
Web of science
Create date
06/06/2012 17:47
Last modification date
20/08/2019 15:11
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