The effect of physiologic derangement in patients with stroke treated with thrombolysis.
BACKGROUND
Body temperature, blood glucose, and blood pressure (BP) may interfere with outcome in patients with acute ischemic stroke treated with thrombolysis.


METHODS
We prospectively studied 127 patients who received thrombolysis with tissue plasminogen activator for acute stroke in Bergen, Norway. Body temperature, blood glucose, and BP were measured before thrombolysis. Maximum body temperature and maximum blood glucose within the first 5 days after thrombolysis and maximum BP within the first 24 hours after thrombolysis were measured. The outcome was measured with modified Rankin scale score obtained at 3 months after stroke onset. Variables were tested using multiple logistic regression analysis after adjusting for National Institute of Health Stroke Scale score before thrombolysis and potential confounders.


RESULTS
The average age of the patients was 63 years and the median National Institute of Health Stroke Scale score was 13. On admission, diabetes mellitus was present in 6% of patients and hypertension in 51% of patients. High body temperature and high blood glucose after thrombolysis were associated with poor prognosis (odds ratio [OR] 2.84, 95% confidence interval [CI] 1.29-6.25, P = .01; OR 1.33, 95% CI 1.02-1.74, P = .03). High body temperature and high blood glucose before thrombolysis were not associated with outcome (OR 0.79, 95% CI 0.39-1.58, P = .5; OR 1.04, 95% CI 0.75-1.20, P = .08). High systolic BP both before and after thrombolysis was associated with poor outcome (OR 1.27, 95% CI 1.03-1.52, P = .025; OR 1.22, 95% CI 1.00-1.44, P = .045). High diastolic BP both before and after thrombolysis was not associated with outcome (OR 1.03, 95% CI 0.97-1.36, P =.85; OR 1.16, 95% CI 0.99-1.46, P = .29).


CONCLUSIONS
The current study indicates that in patients with ischemic stroke, high body temperature and high blood glucose after thrombolysis are associated with poor prognosis. Frequent monitoring of these parameters and the appropriate treatment of it, if elevated, are important during the first few days after thrombolysis. High systolic BP both before and after thrombolysis was associated with poor outcome. This finding may support the practice of reducing systolic BP below 185 mm Hg both before and after thrombolysis.
Idicula
Titto T
TT
Department of Neurology, Haukeland University Hospital, Bergen, Norway. idic@helse-bergen.no
Waje-Andreassen
Ulrike
U
Brogger
Jan
J
Naess
Halvor
H
Lundstadsveen
Maria Therese
MT
Thomassen
Lars
L
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D001831:Body Temperature; D005260:Female; D005334:Fever / Q000150:complications* / Q000503:physiopathology; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications*; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D001786:Blood Glucose; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator