Serum glucose level and diabetes predict tissue plasminogen activator-related intracerebral hemorrhage in acute ischemic stroke.
OBJECTIVE
Five pretreatment variables (P<0.1 univariate analysis), including serum glucose (>300 mg/dL), predicted symptomatic intracerebral hemorrhage (ICH) in the National Institute of Neurological Disorders and Stroke rtPA trial. We retrospectively studied stroke patients treated <3 hours from onset with intravenous rtPA at 2 institutions to evaluate the role of these variables in predicting ICH.


METHODS
Baseline characteristics, including 5 prespecified variables (age, baseline glucose, smoking status, National Institutes of Health Stroke Scale [NIHSS] score, and CT changes [>33% middle cerebral artery territory hypodensity]), were reviewed in 138 consecutive patients. Variables were evaluated by logistic regression as predictors of all hemorrhage (including hemorrhagic transformation) and symptomatic hemorrhage on follow-up CT scan. Variables significant at P<0.25 level were included in a multivariate analysis. Diabetes was substituted for glucose in a repeat analysis.


RESULTS
Symptomatic hemorrhage rate was 9% (13 of 138). Any hemorrhage rate was 30% (42 of 138). Baseline serum glucose (5.5-mmol/L increments) was the only independent predictor of both symptomatic hemorrhage [OR, 2.26 (CI, 1.05 to 4.83), P=0.03] and all hemorrhage [OR, 2.26 (CI, 1.07 to 4.69), P=0.04]. Serum glucose >11.1 mmol/L was associated with a 25% symptomatic hemorrhage rate. Baseline NIHSS (5-point increments) was an independent predictor of all hemorrhage only [OR, 12.42 (CI, 1.64 to 94.3), P=0.01]. Univariate analysis demonstrated a trend for nonsmoking as a predictor of all hemorrhage [OR, 0.45 (CI, 0.19 to 1. 08), P=0.07]. Diabetes was also an independent predictor of ICH when substituted for glucose in repeat analysis.


CONCLUSIONS
Serum glucose and diabetes were predictors of ICH in rtPA-treated patients. This novel association requires confirmation in a larger cohort.
Demchuk
A M
AM
University of Texas-Houston, Department of Neurology, Stroke Program, 77030, USA.
Morgenstern
L B
LB
Krieger
D W
DW
Linda Chi
T
T
Hu
W
W
Wein
T H
TH
Hardy
R J
RJ
Grotta
J C
JC
Buchan
A M
AM
D000208:Acute Disease; D000368:Aged; D001786:Blood Glucose; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy / Q000378:metabolism; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000150:complications / Q000378:metabolism; D002561:Cerebrovascular Disorders / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000378:metabolism; D008297:Male; D010960:Plasminogen Activators / Q000037:antagonists & inhibitors*; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000009:adverse effects
D001786:Blood Glucose; D010960:Plasminogen Activators