Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long term follow up study

Weir, Christopher; Murray, Gordon D.; Dyker, A; Lees, Kennedy R.

doi:10.1136/bmj.314.7090.1303

Cited by 476 publications

(334 citation statements)

References 22 publications

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“…Hyperglycaemia during the acute stroke period may be caused by premorbid glucose metabolism [8,9] or a stress reaction induced by severe neurological injury [10,11].…”

Section: Discussionmentioning

confidence: 99%

Effects of glucose level on early and long-term mortality after intracerebral haemorrhage: the Acute Brain Bleeding Analysis Study

et al. 2009

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Aims/hypothesis Admission hyperglycaemia is associated with a poor outcome in patients with ischaemic stroke. However, its prognostic effects after intracerebral haemorrhage (ICH) are still unclear. Methods We prospectively enrolled patients with ICH at 33 centres in Korea between October 2002 and March 2004. A total of 1,387 patients who had ICH and underwent brain computed tomography within 48 h of symptom onset were included in the study (n=1,387). Clinical information and radiological findings were collected at admission. Glucose levels were examined in relation to early (up to 30 days after ictus) and long-term (after 30 days) mortality rates using Cox regression analysis. To eliminate short-term effects, long-term mortality rate analysis was performed on surviving patients for more than 30 days. Results The long-term mortality rate was 21.1% after a mean follow-up of 434.3±223.2 days and was found to increase significantly with glucose quartile (p<0.001). Admission glucose level was an independent risk factor for early mortality (per mmol/l; adjusted HR 1.10 [95% CI 1.01-1.19]), but not for long-term mortality. Moreover, when analysis was restricted to patients without diabetes, glucose level was found to be an independent risk factor for post-ICH mortality (n=1,119; adjusted HR 1.10 [95% CI 1.03-1.17]) and had marginal significance for early (p= 0.053) and long-term mortality (p=0.09). Conclusions/interpretation We found that admission glucose levels were associated with early mortality after ICH. In patients without diabetes, admission glucose levels were associated with long-term mortality. We therefore suggest that intensive lowering of glucose level should be further investigated in ICH patients.

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“…Hyperglycaemia during the acute stroke period may be caused by premorbid glucose metabolism [8,9] or a stress reaction induced by severe neurological injury [10,11].…”

Section: Discussionmentioning

confidence: 99%

Effects of glucose level on early and long-term mortality after intracerebral haemorrhage: the Acute Brain Bleeding Analysis Study

et al. 2009

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“…Blood glucose was also measured from a finger by a glucometer (Medisafe FIT; Terumo, Tokyo, Japan) 4 times a day to calibrate the blood glucose values of the CGM device. Hyperglycemia was defined as a blood glucose level over 8 mmol/L (144 mg/dL), and hypoglycemia was defined as a level below 4 mmol/L (72 mg/dL), based on previous studies 17, 18, 19. Eight blood glucose parameters were evaluated using CGM: (1) maximum, (2) minimum, (3) mean, and (4) SD of blood glucose levels, (5) area under the curve more than 8 mmol/L blood of glucose (8AUC), (6) distribution time more than 8 mmol/L of blood glucose (8time‐ratio), (7) coefficient of variation, and (8) presence of a blood glucose level less than 4 mmol/L over 72 hours (Figure).…”

Section: Methodsmentioning

confidence: 99%

Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring

Wada

Yoshimura

Inoue

et al. 2018

JAHA

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BackgroundThe purpose of this study was to examine the relationships between glucose parameters obtained by continuous glucose monitoring and clinical outcomes in acute stroke patients.Methods and ResultsConsecutive patients with acute ischemic stroke or intracerebral hemorrhage within 24 hours after onset were included. A continuous glucose monitoring device (iPro2) was attached for the initial 72 hours after emergent admission. Eight glucose parameters were obtained from continuous glucose monitoring: maximum, minimum, mean, and SD of blood glucose levels, as well as area under the curve more than 8 mmol/L of blood glucose, distribution time more than 8 mmol/L of blood glucose, coefficient of variation (%CV), and presence of time less than 4 mmol/L over 72 hours. The primary outcome measure was death or dependency at 3 months (modified Rankin Scale score ≥3). One hundred patients with acute ischemic stroke (n=58) or intracerebral hemorrhage (n=42) were included. Blood glucose levels varied between 5.2±1.4 and 11.4±3.2 mmol/L over 72 hours, with area under the curve more than 8 mmol/L of blood glucose of 0.7±1.4 min×mmol/L, distribution time more than 8 mmol/L of blood glucose of 31.7±32.7%, coefficient of variation of 15.5±5.4%, and presence of hypoglycemia in 20% of overall patients. Mean glucose level (adjusted odds ratio, 1.60, 95% confidence interval, 1.12–2.28/1 mmol/L), area under the curve more than 8 mmol/L of blood glucose (2.13, 1.12–4.02/1 min×mmol/L), and distribution time more than 8 mmol/L of blood glucose (1.25, 1.05–1.50/10%) were related to death or dependency for overall patients, as well as for acute ischemic stroke patients (2.05, 1.15–3.65; 2.38, 1.04–5.44; 1.85, 1.10–3.10, respectively).ConclusionsHigh mean glucose levels, distribution time more than 8 mmol/L of blood glucose, and areas under the curve more than 8 mmol/L of blood glucose during the initial 72 hours of acute stroke were associated with death or dependency at 3 months.

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“…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.…”

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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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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Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long term follow up study

Cited by 476 publications

References 22 publications

Effects of glucose level on early and long-term mortality after intracerebral haemorrhage: the Acute Brain Bleeding Analysis Study

Effects of glucose level on early and long-term mortality after intracerebral haemorrhage: the Acute Brain Bleeding Analysis Study

Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring

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

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