Hyperglycaemia and Mortality from Acute Stroke

Tracey, Fergal; Crawford, Vivienne; Lawson, J. T.; Buchanan, K.D.; Stout, Robert W.

doi:10.1097/00132586-199404000-00053

Cited by 18 publications

(22 citation statements)

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“…A systematically review of the existing data showed that in patients with no history of diabetes who have an ischemic stroke, even moderately elevated glucose levels are associated with both a 3-fold higher risk of short-term mortality and an increased risk of poor functional recovery compared with lower glucose levels [31]. Many studies have shown higher mean admission glucose level in nonsurvivors of stroke compared with survivors [32][33][34]. Furthermore, two large studies demonstrated that glucose level at hospital admission was a significant predictor of mortality [35] or poor functional recovery [36] after stroke independent of other prognostic factors.…”

Section: Discussionmentioning

confidence: 99%

Predictors of In-Hospital Mortality after Acute Ischemic Stroke in Subjects with and without Diabetes Mellitus

Papazafiropoulou¹,

Sotiropoulos²,

Skliros³

et al. 2009

TOGMJ

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Abstract:Background: Diabetes mellitus is a well-established risk factor for ischemic stroke and is associated with increased in-hospital mortality. The aim of the present study was to determine the potential predictors of in-hospital mortality after an ischemic stroke in diabetic and nondiabetic subjects. Methods: 159 diabetic subjects (66 males / 93 females, mean age ± SD: 77.4 ± 6.4 years) and 159 non diabetic subjects (66 males / 93 females, mean age ± SD: 77.3 ± 5.2 years) hospitalized for ischemic stroke were studied. Demographic characteristics and laboratory tests on admission as well as outcome were recorded. Brain computed tomography scan was performed in all study subjects. Results: In-hospital death rates did not differ between the diabetic and the nondiabetic patients [36 (22.6%) vs. 27 (17.0%), respectively, P = 0.20]. In the diabetic study group multivariate analysis, after controlling for CRP, total cholesterol, LDL-C, urea and creatinine levels, demonstrated that death was related with WBC count (OR: 1.002, 95% CI: 1.001-1.004, P = 0.005), glucose levels (OR: 1.007, 95% CI: 1.002-1.012, P = 0.008), and UA levels (OR: 1.51, 95% CI: 1.003-2.260, P = 0.05). In the nondiabetic study group, after controlling for WBC count, CRP, total cholesterol and LDL-C levels, death was related only with glucose levels (OR: 1.016, 95% CI: 1.001-1.031, P = 0.03). Conclusions: WBC count and UA levels on hospital admission are independent predictors for in-hospital mortality in diabetic subjects with ischemic stroke. Plasma glucose levels are predictor for in-hospital mortality in both diabetic and nondiabetic subjects.

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Section: Discussionmentioning

confidence: 99%

Predictors of In-Hospital Mortality after Acute Ischemic Stroke in Subjects with and without Diabetes Mellitus

Papazafiropoulou¹,

Sotiropoulos²,

Skliros³

et al. 2009

TOGMJ

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“…The definition of diabetes was not specified in 1 study, 28 and 3 studies excluded patients with diabetes. 7,11,39 The definition of stress hyperglycemia also varied among studies. Most studies did not specify whether whole blood or plasma glucose was measured.…”

Section: Description Of Studiesmentioning

confidence: 99%

Stress Hyperglycemia and Prognosis of Stroke in Nondiabetic and Diabetic Patients

Capes

Hunt²,

Malmberg³

et al. 2001

Stroke

1,604

1,175

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Background and Purpose-"Stress" hyperglycemia may be associated with increased mortality and poor recovery in diabetic and nondiabetic patients after stroke. A systematic review and meta-analysis of the literature relating acute poststroke glucose levels to the subsequent course were done to summarize and quantify this relationship. Methods-A comprehensive literature search was done for cohort studies reporting mortality and/or functional recovery after stroke in relation to admission glucose level. Relative risks in hyperglycemic compared with normoglycemic patients with and without diabetes were calculated and meta-analyzed when possible. Results-Thirty-two studies were identified; relative risks for prespecified outcomes were reported or could be calculated in 26 studies.

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“…It has been argued that those with stress hyperglycemia have a poor prognosis conferred by the severity of the initial lesion, whereas those with DM have a poor prognosis because of the natural history of stroke in diabetic patients, and therefore active intervention to normalize mild to moderate elevations of blood glucose is often not instituted. 10,16 However, hyperglycemia is known to be a risk factor for poor outcome following stroke irrespec-tive of diabetic status, although a definitive statement on causality cannot be made in the absence of randomized controlled trial data. In addition, active intervention to normalize blood glucose levels in patients with acute myocardial infarction (MI) and hyperglycemia has become standard practice following the DIGAMI study.…”

mentioning

confidence: 99%

Glucose Potassium Insulin Infusions in the Treatment of Acute Stroke Patients With Mild to Moderate Hyperglycemia

Scott

Robinson

French

et al. 1999

Stroke

236

127

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Background and Purpose-Hyperglycemia following acute stroke is strongly associated with subsequent mortality and impaired neurological recovery, but it is unknown whether maintenance of euglycemia in the acute phase improves prognosis. Furthermore, the safety of such intervention is not established. Methods-In an explanatory, randomized, controlled trial to test safety, 53 acute (within 24 hours of ictus) stroke patients with mild to moderate hyperglycemia (plasma glucose between 7.0 and 17.0 mmol/L) were randomized to receive either a 24-hour infusion of 0.9% (154 mmol/L) saline or a glucose potassium insulin (GKI) infusion at 100 mL/h. The GKI consisted of 16 U human soluble insulin and 20 mmol potassium chloride in 500 mL 10% glucose. Blood glucose was measured every 2 hours with Boehringer Mannheim Glycaemie test strips, pulse and blood pressure were measured every 4 hours, and plasma glucose samples were taken every 8 hours. Insulin concentration in the GKI was altered according to BM glucose values. Results-There were no statistically significant differences between the 2 groups at baseline. Twenty-five patients received GKI, 1 of whom required intravenous glucose for symptomatic hypoglycemia. Plasma glucose levels were nonsignificantly lower in the GKI group throughout the infusion period. Four-week mortality in the GKI group was 7 (28%), compared with 8 (32%) in the control group. Conclusions-GKI infusions can be safely administered to acute stroke patients with mild to moderate hyperglycemia producing a physiological but attenuated glucose response to acute stroke, the effectiveness of which remains to be elucidated. (Stroke. 1999;30:793-799.)

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Hyperglycaemia and Mortality from Acute Stroke

Cited by 18 publications

References 0 publications

Predictors of In-Hospital Mortality after Acute Ischemic Stroke in Subjects with and without Diabetes Mellitus

Predictors of In-Hospital Mortality after Acute Ischemic Stroke in Subjects with and without Diabetes Mellitus

Stress Hyperglycemia and Prognosis of Stroke in Nondiabetic and Diabetic Patients

Glucose Potassium Insulin Infusions in the Treatment of Acute Stroke Patients With Mild to Moderate Hyperglycemia

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