Potentially reversible factors during the very acute phase of stroke and their impact on the prognosis: is there a large therapeutic potential to be explored?
In the Copenhagen Stroke Study, we evaluated the combined impact on stroke outcome of potentially treatable factors such as acute body temperature, blood glucose, and stroke in progression. The patients were stratified into two groups: (1) patients with 'good' prognostic parameters (body temperature on admission < or = 37.0 degrees C and plasma glucose on admission < or = 6.5 mmol/l and who did not develop stroke in progression) and (2) patients with correspondingly 'poor' prognostic parameters. A poor outcome was observed in 4% of the patients with good prognostic parameters versus in 49% of the patients with poor prognostic parameters (p < 0.01). In the multivariate analysis which also included stroke severity, blood glucose contributed significantly to poor outcome with an odds ratio (OR) of 1.2/1.0 mmol/l increase, body temperature with an OR of 2.2/1 degrees C increase, and stroke in progression with an OR of 2.9. However, the combined effect of all three factors was more than additive with an OR of 10.0 (95% CI 1.5-56; p < 0.01). We have shown that in human stroke a strong and more than additive association exists between potentially reversible parameters and outcome. Intervention trials can prove whether these marked relations are causal.
Jørgensen
H S
HS
Department of Neurology, Copenhagen, Denmark. hsj@dadlnet.dk
Reith
J
J
Nakayama
H
H
Kammersgaard
L P
LP
Houth
J G
JG
Raaschou
H O
HO
Olsen
T S
TS
D000208:Acute Disease; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications; D001786:Blood Glucose / Q000032:analysis; D001831:Body Temperature; D003718:Denmark; D048909:Diabetes Complications; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000150:complications; D016017:Odds Ratio; D011379:Prognosis; D012008:Recurrence; D020521:Stroke / Q000145:classification / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome
D001786:Blood Glucose