Predictors of hyperacute clinical worsening in ischemic stroke patients receiving thrombolytic therapy.
OBJECTIVE
Although long-term outcome determinants in acute ischemic stroke (AIS) patients have been defined, less is known about those predicting hyperacute worsening after thrombolytic therapy (TT). We investigated predictors of short-term clinical worsening (National Institutes of Health Stroke Scale [NIHSS] change > or =4 within 24 hours of admission).


METHODS
We studied 201 AIS patients who received TT within 6 hours of symptom onset. We determined baseline demographics, comorbidities, NIHSS at baseline and at 24 hours after TT, head computed tomography scan before and within 24 hours after TT, and angiographic recanalization in patients treated with intra-arterial (IA) thrombolysis. Significance of relationships was evaluated by t test or Wilcoxon signed rank sum test. Logistic regression model (LRM) was fitted to determine independence of significant variables.


RESULTS
Of 201 patients, 13% worsened, 39% improved, and 48% remained unchanged 24 hours after TT. Most patients (72%) received IA thrombolysis. Patients who deteriorated, compared with those who improved, were more likely to have complicating intracranial hemorrhage (ICH; P<0.001), absent recanalization (P=0.026), and higher blood glucose (BG; P=0.049). Hyperglycemia (>150 mg/dL) was greater in patients who worsened even in presence of recanalization (P=0.004, odds ratio [OR] 6.47). LRM showed that adjusted OR for increased risk of bad outcome and mortality for an increase of BG by 50 mg/dL is 1.56 and 1.38, respectively.


CONCLUSIONS
Hyperglycemia and ICH are independent predictors of hyperacute worsening in AIS patients receiving TT. Although recanalization is the purpose of IA thrombolysis, its impact on clinical improvement may not be apparent without strict BG control.
Leigh
Richard
R
Cerebrovascular Center, Neurosciences Critical Care, Department of Neurology, Neurosurgery, and Radiology, University Hospitals of Cleveland and Case Western Reserve University, Ohio 44106, USA.
Zaidat
Osama O
OO
Suri
Muhammad F
MF
Lynch
Gwendolyn
G
Sundararajan
Sophia
S
Sunshine
Jeffrey L
JL
Tarr
Robert
R
Selman
Warren
W
Landis
Dennis M D
DM
Suarez
Jose I
JI
D000368:Aged; D001786:Blood Glucose; D002545:Brain Ischemia / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
D001786:Blood Glucose; D010960:Plasminogen Activators