Blood glucose variability during the first 24 hours and prognosis in acute stroke patients treated with IV thrombolysis

Abstract

INTRODUCTION: Hyperglycemia in acute ischemic stroke decreases the effectiveness of intravenous tissue plasminogen activator (IV tPA) and increases its hemorrhagic complications. Therefore, optimization of blood glucose (BG) is suggested. But, no consensus is achieved on which of the BG parameters to be used such as admission BG, post-treatment BG, first day maximum and average BG (maxBG and aveBG), or BG variability indices such as the standard deviation of mean BG (SDBG), coefficient of variation of BG (CVBG) and J-index. METHODS: Admission and 24h BG were measured in 145 acute stroke patients (55% female, age: 70±13 yr; NIHSS: 14 ± 6, symptom-to-needle time: 160 ± 58 minutes) treated with IV tPA. BG variability indices were evaluated in 107 patients with serial BG measurement available. RESULTS: AveBG was significantly higher in patients with 3rd month mRS>2 (46.2%), but admission BG, SDBG, CVBG and J-index were not significantly different. An exploratory regression analysis indicated that the connection of aveBG to worse prognosis (β=-0.155, p=0.045) persisted after adjustment for admission NIHSS, age and DM history. No BG parameter predicted symptomatic tPA-associated type-II intracerebral hemorrhage (6.7%), albeit these patients had marginally higher average BG levels (p=0.045). Presence of diabetes, HbA1c, admission BG, average first day BG and variability indices had not modified the beneficial (52%) and dramatic response (28%) to IV tPA. DISCUSSION and CONCLUSION: Sustained hyperglycemia, not glucose variability, during the first 24 hour predicts poor prognosis in acute stroke patients treated with IV thrombolysis.

Prognostic value of glucose fluctuation in patients undergoing thrombolysis or thrombectomy due to acute ischemic stroke

“…This may be due to multifactorial and previously undetectable DM, impaired glucose tolerance and insufficient exercise capacity due to loss of strength caused by ischemic stroke, and insufficiency of the pituitary-sympatho-adrenal axis or its reaction to stress [4]. Consequently, hyperglycemia occurring in the acute period extends the duration of hospital stay, thus increasing cost and mortality [5]. During predictive risk assessment in patients administered with intravenous recombinant tissue plasminogen activator (iv r-tPA), the presence or absence of hyperglycemia, severity of stroke, and time of initiation of treatment are highly important in terms of prognosis and mortality [6].…”