Unfavorable neurological outcome in diabetic patients with acute ischemic stroke is associated with incomplete recanalization after intravenous thrombolysis

Tang, Huan; Zhang, Sheng; Yan, Shiyu; Liebeskind, David S; Sun, Jianyong; Ding, Xi; Zhang, Minming; Lou, Min

doi:10.1136/neurintsurg-2014-011643

Cited by 23 publications

(23 citation statements)

References 31 publications

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“…Although there is some conflicting evidence in studies of people with ischemic 13,14,51 and hemorrhagic stroke 38 , diabetes is typically associated with poorer functional outcome 8,12,26,27,50,55 , especially in poorly controlled diabetes (HbA1c >7%) 91 . Diabetes has also been associated with worse neurological deterioration (decrease of National Institute of Health Stroke Scale points <4 at 24 h, or <8 at day 7), poorer recovery (mRS >1 at 3 months) and increased risk of hemorrhagic development 72 in people treated with thrombolysis for ischemic stroke 56 . An explanation for this might be incomplete recanalization after thrombolysis, as suggested in one study 92 .…”

Section: Discussionmentioning

confidence: 99%

“…The relationship between diabetes and neurological outcome is summarized in Table 1. Six studies 12,26,50,[55][56][57] showed an association between diabetes and poorer neurological outcome, whereas four studies 8,13,14,38 did not show a difference. Between these studies, the outcome measures used were the modified Rankin scale (mRS) 8,14,26,38,50,[55][56][57] , Functional Independence Measure 12,13 and the Scandinavian stroke scale 14 .…”

Section: Diabetes and Outcomes After Strokementioning

confidence: 91%

“…Between these studies, the outcome measures used were the modified Rankin scale (mRS) 8,14,26,38,50,[55][56][57] , Functional Independence Measure 12,13 and the Scandinavian stroke scale 14 . The diagnosis of diabetes differed between the studies, with some using medical history alone or medical coding [12][13][14]57 , whereas others carried out either FBG 8,38,50 , HbA1c 55 or both 26,56 .…”

Section: Diabetes and Outcomes After Strokementioning

confidence: 99%

See 2 more Smart Citations

Prevalence of diabetes and its effects on stroke outcomes: A meta‐analysis and literature review

Lau

Lew

Borschmann

et al. 2018

J of Diabetes Invest

321

205

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Section: Discussionmentioning

confidence: 99%

Section: Diabetes and Outcomes After Strokementioning

confidence: 91%

Section: Diabetes and Outcomes After Strokementioning

confidence: 99%

See 1 more Smart Citation

Prevalence of diabetes and its effects on stroke outcomes: A meta‐analysis and literature review

Lau

Lew

Borschmann

et al. 2018

J of Diabetes Invest

321

205

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“…Previous studies have shown that stroke severity and serum glucose level had a significant influence on intracerebral hemorrhage after intravenous tissue plasminogen activator therapy [22][23][24]40], which was consistent with our findings, even though we used SSI as a substitute for NIHSS score as a measure of stroke severity. In addition to the glucose level, diabetes may be associated with poor outcome of rt-PA therapy [41,42]. One study found that in the diabetic subgroup, the glycated hemoglobin index was positively correlated with symptomatic intracranial hemorrhage [40].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with Outcomes of Recombinant Tissue Plasminogen Activator Therapy in Patients with Acute Ischemic Stroke

Tseng

Lee

et al. 2020

IJERPH

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Ischemic stroke is the most common type of stroke, and early interventional treatment is associated with favorable outcomes. In the guidelines, thrombolytic therapy using recombinant tissue-type plasminogen activator (rt-PA) is recommended for eligible patients with acute ischemic stroke. However, the risk of hemorrhagic complications limits the use of rt-PA, and the risk factors for poor treatment outcomes need to be identified. To identify the risk factors associated with in-hospital poor outcomes in patients treated with rt-PA, we analyzed the electronic medical records of patients who were diagnosed with acute ischemic stroke and treated for rt-PA at Chang Gung Memorial Hospitals from 2006 to 2016. In-hospital death, intensive care unit (ICU) stay, or prolonged hospitalization were defined as unfavorable treatment outcomes. Medical history variables and laboratory test results were considered variables of interest to determine risk factors. Among 643 eligible patients, 537 (83.5%) and 106 (16.5%) patients had favorable and poor outcomes, respectively. In the multivariable analysis, risk factors associated with poor outcomes were female gender, higher stroke severity index (SSI), higher serum glucose levels, lower mean corpuscular hemoglobin concentration (MCHC), lower platelet counts, and anemia. The risk factors found in this research could help us study the treatment strategy for ischemic stroke.

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“…DM has been associated with a significantly higher incidence of death [2][3][4][5] , dependency [4,6] and recurrent stroke [3,7] and with an increased risk of intracerebral hemorrhage following thrombolysis (OR 3.61) after stroke [8] , which becomes higher in those with poor glycemic control [9] . Our recent study of 419 acute stroke patients demonstrated that intravenous thrombolysis failed to improve outcome in patients with DM, which was also shown to be associated with incomplete recanalization after thrombolysis (OR 0.268) in patients with large vessel occlusion [10] .…”

mentioning

confidence: 99%

Blood Brain Barrier Disruption in Diabetic Stroke Related to Unfavorable Outcome

Jackson

et al. 2016

Cerebrovasc Dis

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Background: Diabetes mellitus (DM) is associated with a wide range of microvascular abnormalities in the brain. These include the dysfunction of the blood brain barrier (BBB). In this study, we test the hypotheses that disruption of the BBB in patients presenting with acute stroke is common in patients with DM and is related to outcome. Methods: Sixty-two consecutive patients with ischemic stroke in the middle cerebral artery territory were enrolled within 3-7 days after onset. In ischemic lesion, BBB disruption was detected by parenchymal enhancement (PE) on 5 min delayed post-contrast T1 weighted imaging. National Institute of Health Stroke Score (NIHSS) assessed neurologic impairment on admission. Clinical outcome at 3 months was classified as unfavorable if the modified Rankin scale was >1. The independent factors associated with clinical outcome were analyzed using multivariate logistic regression analysis and OR with its 95% CIs were estimated. Results: An unfavorable stroke outcome was found in 19 diabetic patients and 21 non-diabetic patients. Diabetic patients had a significantly higher frequency of PE than non-diabetic patients (58.6 vs. 27.3%, p = 0.013) and DM was independently associated with PE (OR 4.40; 95% CI 1.22-15.83; p = 0.023). PE was significantly more common in diabetic patients with unfavorable stroke outcome (73.7%) than in other 3 subgroups: diabetic patients with favorable stroke outcome (30.0%), non-diabetic patients with favorable stroke outcome (38.1%) and unfavorable stroke outcome (8.3%; p = 0.002). PE was independently associated with unfavorable outcome (UO) in diabetic stroke (DS; OR 7.04; 95% CI 1.20-41.52; p = 0.031). Admission NIHSS score was associated with UO in non-DS (NDS) (OR 1.71; 95% CI 1.10-2.66; p = 0.017). Conclusions: Compared with NDS, DS had increased BBB disruption defined by the presence of PE. A different form of the relationship between admission NIHSS and UO in NDS, BBB disruption was related with UO in diabetic patients after stroke.

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Unfavorable neurological outcome in diabetic patients with acute ischemic stroke is associated with incomplete recanalization after intravenous thrombolysis

Abstract: Diabetic patients with AIS had unfavorable neurological outcome, potentially linked to incomplete recanalization after IVT.

Cited by 23 publications

References 31 publications

Prevalence of diabetes and its effects on stroke outcomes: A meta‐analysis and literature review

Prevalence of diabetes and its effects on stroke outcomes: A meta‐analysis and literature review

Risk Factors Associated with Outcomes of Recombinant Tissue Plasminogen Activator Therapy in Patients with Acute Ischemic Stroke

Blood Brain Barrier Disruption in Diabetic Stroke Related to Unfavorable Outcome

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