title: Predictors of hyperacute clinical worsening in ischemic stroke patients receiving thrombolytic therapy.
abstract: 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.
authors.affiliation: Cerebrovascular Center, Neurosciences Critical Care, Department of Neurology, Neurosurgery, and Radiology, University Hospitals of Cleveland and Case Western Reserve University, Ohio 44106, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Leigh
authors.forename: Osama O
authors.initials: OO
authors.lastname: Zaidat
authors.forename: Muhammad F
authors.initials: MF
authors.lastname: Suri
authors.forename: Gwendolyn
authors.initials: G
authors.lastname: Lynch
authors.forename: Sophia
authors.initials: S
authors.lastname: Sundararajan
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Sunshine
authors.forename: Robert
authors.initials: R
authors.lastname: Tarr
authors.forename: Warren
authors.initials: W
authors.lastname: Selman
authors.forename: Dennis M D
authors.initials: DM
authors.lastname: Landis
authors.forename: Jose I
authors.initials: JI
authors.lastname: Suarez
mesh_terms: 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
chemical_list: D001786:Blood Glucose; D010960:Plasminogen Activators