Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long-term follow up study.
OBJECTIVE
To determine whether raised plasma glucose concentration independently influences outcome after acute stroke or is a stress response reflecting increased stroke severity.


METHODS
Long-term follow up study of patients admitted to an acute stroke unit.


METHODS
Western Infirmary, Glasgow.


METHODS
811 patients with acute stroke confirmed by computed tomography. Analysis was restricted to the 750 non-diabetic patients.


METHODS
Survival time and placement three months after stroke.


RESULTS
645 patients (86%) had ischaemic stroke and 105 patients (14%) haemorrhagic stroke. Cox's proportional hazards modelling with stratification according to Oxfordshire Community Stroke Project categories identified increased age (relative hazard 1.36 per decade; 95% confidence interval 1.21 to 1.53), haemorrhagic stroke (relative hazard 1.67; 1.22 to 2.28), time to resolution of symptoms > 72 hours (relative hazard 2.15; 1.15 to 4.05), and hyperglycaemia (relative hazard 1.87; 1.43 to 2.45) as predictors of mortality. The effect of glucose concentration on survival was greatest in the first month.


CONCLUSIONS
Plasma glucose concentration above 8 mmol/l after acute stroke predicts a poor prognosis after correcting for age, stroke severity, and stroke subtype. Raised plasma glucose concentration is therefore unlikely to be solely a stress response and should arguably be treated actively. A randomised trial is warranted.
Weir
C J
CJ
University Department of Medicine and Therapeutics, Western Infirmary, Glasgow.
Murray
G D
GD
Dyker
A G
AG
Lees
K R
KR
D000368:Aged; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology*; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D013312:Stress, Physiological; D016019:Survival Analysis; D015996:Survival Rate