Decreased mortality by normalizing blood glucose after acute ischemic stroke.
OBJECTIVE
Hyperglycemia after cerebral ischemia exacerbates brain injury and worsens the outcome of stroke patients. The authors sought to examine the effect of glycemic control on mortality after acute stroke.


METHODS
This was a retrospective study of patients discharged with a diagnosis of ischemic stroke during a 40-month period from a large urban U.S. health system. Patients were compared by initial blood glucose (BG) levels and by glycemic control during the first 48 hours of hospitalization.


RESULTS
Of 960 patients with thromboembolic stroke, 373 (38.9%) were hyperglycemic (BG > or = 130 mg/dL) on hospital admission. Admission hyperglycemia was associated with a higher mortality rate than was euglycemia (odds ratio [OR] = 3.15; 95% confidence interval [CI] = 1.45 to 6.85; p = 0.004). Persistent hyperglycemia (PerHyp) during 48 hours of hospitalization was associated with even higher mortality rate (unadjusted logistic regression, OR = 6.54; 95% CI = 2.41 to 17.87; p < 0.001). Glycemic control (normalization of BG to < 130 mg/dL) was associated with a 4.6-fold decrease in mortality risk as compared with the case of patients with PerHyp (p < 0.001). Multiple logistic regression showed glycemic control to be a strong independent determinant of survival (OR = 5.95; 95% CI = 1.24 to 28.6; p = 0.026) after acute stroke even after adjustment for age, gender, concomitant hypertension and diabetes, and stroke severity.


CONCLUSIONS
Admission hyperglycemia is associated with a worse outcome after stroke than is euglycemia. Normalization of blood glucose during the first 48 hours of hospitalization appears to confer a potent survival benefit in patients with thromboembolic stroke.
Gentile
Nina T
NT
Temple University School of Medicine, Philadelphia, PA 19140, USA. ngentile@temple.edu
Seftchick
Michael W
MW
Huynh
Tien
T
Kruus
Linda K
LK
Gaughan
John
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis*; D002545:Brain Ischemia / Q000097:blood* / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D020521:Stroke / Q000097:blood* / Q000401:mortality*; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
D001786:Blood Glucose