The influence of hyperglycemia on outcome of cerebral infarction.
OBJECTIVE
To determine whether hyperglycemia in the acute stroke period is associated with worse survival and functional outcome after accounting for acute stress response and chronic hyperglycemia.


METHODS
Prospective, county-wide, multicenter cohort study.


METHODS
A community hospital, a university hospital, and a Veterans Affairs hospital.


METHODS
A cohort of 146 patients hospitalized with new atherothrombotic stroke.


METHODS
Admission blood glucose concentration, demographic characteristics of patients, 24-hour urinary catecholamine, serum cortisol, and glycosylated hemoglobin levels; outcomes included mortality and functional outcome (Barthel index and Fugl-Meyer score) at 5, 30, 90, and 180 days after stroke.


RESULTS
Of the 996 patients with possible acute stroke who were screened, 146 (15%) were eligible for and consented to participate in the study; in most cases, exclusion from study was based on the absence of acute, atherothrombotic stroke. Overall, no evidence was found of a significant univariate association between admission blood glucose level and survival (relative risk, 1.02; 95% Cl, 0.94 to 1.09) or functional outcome (univariate regression coefficient for adjusted Fugl-Meyer score at day 30, - 0.36; Cl, - 1.08 to 0.27). This absence of an association persisted after adjustment for significant predictors of outcome in a multivariate model.


CONCLUSIONS
These data do not support an association between level of glycemia and outcome from acute stroke.
Matchar
D B
DB
Duke University, Durham, NC.
Divine
G W
GW
Heyman
A
A
Feussner
J R
JR
D000208:Acute Disease; D000368:Aged; D002395:Catecholamines / Q000652:urine; D002544:Cerebral Infarction / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D004185:Disability Evaluation; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006943:Hyperglycemia / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D016019:Survival Analysis
D002395:Catecholamines; D006442:Glycated Hemoglobin; D006854:Hydrocortisone