Hyperglycemia as an independent predictor of worse outcome in non-diabetic patients presenting with acute ischemic stroke.
OBJECTIVE
To determine if differences in outcome exist between diabetic and non-diabetic patients who present to the Emergency Department (ED) with acute ischemic stoke (AIS) and elevated blood glucose.


METHODS
The study population consisted of 447 consecutive patients who presented to the ED with AIS within 24 h of symptom onset and had blood glucose measured on presentation. Hyperglycemia was defined as >130 mg/dl. Outcomes studied included infarct volume, stroke severity (NIH Stroke Scale), functional impairment (modified Rankin Score), and 90-day mortality. Patients with hyperglycemia were then stratified into those with and without a prior history of diabetes mellitus (DM) for the purposes of analysis.


RESULTS
Patients with hyperglycemia exhibited significantly greater stroke severity (P = 0.002) and greater functional impairment (P = 0.004) than those with normoglycemia. Patients with hyperglycemia were 2.3 times more likely to be dead at 90 days compared to those with normal glucose (P < 0.001). Stroke severity (P < 0.001) and functional impairment (P < 0.001) were both significantly worse in patients with hyperglycemia and no prior history of DM, when compared to patients with hyperglycemia and previously diagnosed DM. Among the patients without a prior history of DM, patients with hyperglycemia were 3.4 times more likely to die within 90 days (P < 0.001) when compared with patients with normoglycemia. In contrast, the hazard ratio was 1.6 among the patients with DM (P = 0.66).


CONCLUSIONS
Hyperglycemia on presentation is associated with significantly poorer outcomes following AIS. Patients with hyperglycemia and no prior history of DM have a particularly poor prognosis, worse than that for patients with known diabetes and hyperglycemia.
Stead
Latha G
LG
Division of Research, Generose G-410, Department of Emergency Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA. stead.latha@mayo.edu
Gilmore
Rachel M
RM
Bellolio
M Fernanda
MF
Mishra
Shaily
S
Bhagra
Anjali
A
Vaidyanathan
Lekshmi
L
Decker
Wyatt W
WW
Brown
Robert D
RD
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D002545:Brain Ischemia / Q000378:metabolism / Q000401:mortality*; D003920:Diabetes Mellitus / Q000378:metabolism / Q000401:mortality*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000378:metabolism / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000378:metabolism / Q000401:mortality*
D001786:Blood Glucose