Effect of acute glycaemic index on clinical outcome after acute stroke.
Studies have shown that hyperglycaemia acutely after stroke independently predicts poorer survival and independence. Whether the change in glycaemic index in the acute phase of stroke has any effect on stroke outcome is unclear. Glycated serum proteins (GSP) reflect blood glucose concentration during the preceding 2 weeks. The aim of this study is to measure the association between the change in GSP % in the first 2 weeks after stroke and outcome. 167 patients were included. 117 (70%) patients were alive at 3 months. Admission glucose was higher in dead patients (7.8 mmol/l) compared to survivors (6.6 mmol/l) (p < 0.01). GSP at day 14 was higher in non survivors (21.8%) compared with survivors (19.1%) (p < 0.0001) as was the change in GSP (2.0 %) in non survivors compared with survivors (0.1%) (p < 0.0001). After adjusting for case mix, the change in GSP % was significantly associated with stroke mortality (p = 0.04). The odds ratio for death at 3 months after stroke associated with every 1% increase in change between GSP day 14 and GSP day 0, was 1.28 (95% CI: 1.1-1.62). Increases in glycaemic index as determined by GSP % are associated with excess in stroke mortality after adjusting for case mix. Intervention trials are required to test the hypothesis that improving glycaemic index after acute stroke improves outcome.
Bhalla
Ajay
A
Department of Public Health Services, Guy's and St Thomas' Hospital, London, UK. bhalla@ajay1.freeserve.co.uk
Sankaralingam
Suki
S
Tilling
Kate
K
Swaminathan
R
R
Wolfe
Charles
C
Rudd
Anthony
A
D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D001798:Blood Proteins / Q000187:drug effects / Q000378:metabolism*; D005260:Female; D006442:Glycated Hemoglobin / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D016015:Logistic Models; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D020521:Stroke / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D016019:Survival Analysis
D001786:Blood Glucose; D001798:Blood Proteins; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C025615:glucosylated serum protein