title: Stress hormone and blood glucose response following acute stroke in the elderly.
abstract: We studied the relation of reactive hyperglycemia, stress hormone response, and outcome in 23 consecutive elderly patients (median age 80 [range 75-92] years) following an acute first stroke. The median delay from the onset of the stroke to the first blood sample (day 0) was 9 (range 4-22) hours. Subsequent blood samples were taken, after fasting, for the determination of blood glucose, cortisol, catecholamine, insulin, C-peptide, glucagon, and lactate concentrations on days 1, 2, 3, 7, 14, 30, and 90. For all 23 patients, a significant relation was found between the blood glucose concentration and survival (p = 0.03) and the blood glucose concentration decreased with time (p less than 0.001). There was also a significant relation between blood glucose concentration and outcome (p = 0.02). For the 15 patients with complete data, the major determinants of the blood glucose concentration were the cortisol, insulin, and glucagon concentrations (all p less than 0.001), which accounted for 42% of the variance. When all the indexes were analyzed together by logistic regression, only the cortisol concentration was related to outcome (p = 0.02). Hyperglycemia following a stroke probably reflects the intensity of the stress hormone response. We have confirmed that hyperglycemia is a predictor of outcome in persons with stroke.
authors.affiliation: University Department of Geriatric Medicine, University Hospital of South Manchester, England.
authors.forename: P A
authors.initials: PA
authors.lastname: O'Neill
authors.forename: I
authors.initials: I
authors.lastname: Davies
authors.forename: K J
authors.initials: KJ
authors.lastname: Fullerton
authors.forename: D
authors.initials: D
authors.lastname: Bennett
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis*; D002561:Cerebrovascular Disorders / Q000097:blood* / Q000401:mortality; D005260:Female; D005934:Glucagon / Q000097:blood; D006728:Hormones / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007328:Insulin / Q000097:blood; D008297:Male; D009994:Osmolar Concentration; D011446:Prospective Studies; D012044:Regression Analysis; D013312:Stress, Physiological / Q000097:blood*; D016019:Survival Analysis
chemical_list: D001786:Blood Glucose; D006728:Hormones; D007328:Insulin; D005934:Glucagon; D006854:Hydrocortisone