Admission glucose level and clinical outcomes in the NINDS rt-PA Stroke Trial

Bruno, Askiel; Levine, Steven R.; Frankel, Michael; Brott, Thomas G.; Yang, Lin; Tilley, Barbara C.; Lyden, Patrick D.; Broderick, Joseph P.; Kwiatkowski, Thomas; Fineberg, S. Edwin

doi:10.1212/wnl.59.5.669

Cited by 469 publications

(331 citation statements)

References 45 publications

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“…Previous studies suggested that a blood glucose level of 160 mg/dL or more may be a cutoff for poor outcomes 20, 24. One study reported a linear relation between admission glucose and an increase in the odds of sICH (OR 1.75 per 100 mg/dL increase in admission glucose) 5. Admission blood glucose levels were identified as a risk factor for sICH after intravenous tPA in several risk models for sICH post‐tPA 11, 25, 26, 27, 28.…”

Section: Discussionmentioning

confidence: 99%

“…This is likely due to hyperglycemia, which is considered a poor prognostic factor in stroke patients 3, 4. Increased admission glucose levels in acute stroke have also been associated with longer in‐hospital stay, increased cost, and mortality 5. Hyperglycemia before reperfusion potentially decreases the beneficial effect of tissue‐type plasminogen activator (tPA)6 given that hyperglycemia may act as an inhibitor of fibrinolysis 7…”

Section: Introductionmentioning

confidence: 99%

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Association of Acute and Chronic Hyperglycemia With Acute Ischemic Stroke Outcomes Post‐Thrombolysis: Findings From Get With The Guidelines‐Stroke

Masrur

Cox

Bhatt

et al. 2015

JAHA

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BackgroundHyperglycemia has been associated with adverse outcomes in patients with acute ischemic stroke (AIS) and may influence outcomes after tissue plasminogen activator (tPA). We sought to analyze the association of acute and chronic hyperglycemia on clinical outcomes in tPA‐treated patients.Methods and ResultsWe identified 58 265 AIS patients from 1408 sites who received tPA from 2009 to 2013 in Get With The Guidelines‐Stroke. Acute hyperglycemia at admission was defined as a plasma glucose level >140 mg/dL. Chronic hyperglycemia was defined by plasma glycosylated hemoglobin (HbA1c) >6.5%. Post‐tPA outcomes were analyzed using logistic regression. Blood glucose >140 mg/dL and HbA1c >6.5 were associated with worse clinical outcomes (symptomatic intracranial hemorrhage [sICH], life‐threatening hemorrhage, and in‐hospital mortality and length of stay) in diabetic and nondiabetic patients. Among patients with documented history of diabetes, increasing admission glucose up to 200 mg/dL was associated with increased adjusted odds ratio (aOR) of in‐hospital mortality (aOR, 1.07) and sICH (aOR, 1.05) per 10 mg/dL increase in blood glucose. Increasing HbA1C to 8% was associated with increased odds of in‐hospital mortality (aOR, 1.19) and sICH (aOR, 1.16) per 1% increase in HbA1c. Similar findings were observed in patients without a documented history of diabetes. There was no further increase in poor outcomes above the blood glucose level of 200 mg/dL or HbA1c >8.ConclusionAcute and chronic hyperglycemia are both associated with increased mortality and worse clinical outcomes in AIS patients treated with tPA. Controlled trials are needed to determine whether acute correction of hyperglycemia can improve outcomes after thrombolysis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of Acute and Chronic Hyperglycemia With Acute Ischemic Stroke Outcomes Post‐Thrombolysis: Findings From Get With The Guidelines‐Stroke

Masrur

Cox

Bhatt

et al. 2015

JAHA

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“…A recent meta-analysis of studies examining hyperglycemia in acute ischemic stroke also reported an increase in mortality rate in patients with hyperglycemia at the time of hospital admission [30]. This finding of poor outcomes with hospital admission hyperglycemia was even more strongly correlated between patients who were treated with the thrombolytic tissue plasminogen activator compared to those who were not treated [38].…”

Section: Hyperglycemia In the Stroke Patientmentioning

confidence: 96%

Care of the Stroke Patient: Routine Management to Lifesaving Treatment Options

2011

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The management of the acute ischemic stroke patient spans the time course from the emergency evaluation and treatment period through to the eventual discharge planning phase of stroke care. In this article we evaluate the literature and describe what have become standard treatments in the care of the stroke patient. We will review the literature that supports the use of a dedicated stroke unit for routine stroke care which has demonstrated reduced rates of morbidity and mortality. Also reviewed is the use of glycemic control in the initial setting along with data supporting the use of prophylactic treatments options in order to aide in the prevention of life threatening medical complications. In addition, lifesaving treatments will be discussed in light of new literature demonstrating reduced mortality in large hemispheric stroke patients undergoing surgical decompressive surgery. Both medical and surgical treatment options are discussed and compared.

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“…44,45 The mechanisms underlying neurologic worsening associated with hyperglycemia are likely multifactorial, and include tissue acidosis, free radical formation, blood-brain barrier disruption, and augmentation of cerebral edema formation. 46 Despite these consistent observations, a definitive study has yet to establish that tight control of glucose improves outcomes. 47 Consensus exists regarding the need to treat hyperglycemia after stroke, and current guidelines recommend a goal glucose concentration of 140 to 180 mg/dL.…”

Section: Glucose Managementmentioning

confidence: 99%

Acute Ischemic Stroke Management: Medical Management

Barrett

Meschia

2010

Semin Neurol

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The initial management of a patient with suspected stroke necessitates a rapid and focused evaluation. Establishing the time of symptom onset, performing a focused neurologic examination, and interpreting ancillary tests facilitates delivery of acute stroke therapies to eligible patients. This review emphasizes the fundamentals of urgent stroke evaluation and evidence-based acute ischemic stroke therapies. Results from randomized clinical trials of intravenous thrombolysis, glucose management, and blood pressure management in acute ischemic stroke patients will be highlighted. External ultrasound as an adjunct to intravenous thrombolysis and treatment of those patients that wake up with stroke symptoms will also be discussed.

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Admission glucose level and clinical outcomes in the NINDS rt-PA Stroke Trial

Cited by 469 publications

References 45 publications

Association of Acute and Chronic Hyperglycemia With Acute Ischemic Stroke Outcomes Post‐Thrombolysis: Findings From Get With The Guidelines‐Stroke

Association of Acute and Chronic Hyperglycemia With Acute Ischemic Stroke Outcomes Post‐Thrombolysis: Findings From Get With The Guidelines‐Stroke

Care of the Stroke Patient: Routine Management to Lifesaving Treatment Options

Acute Ischemic Stroke Management: Medical Management

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