Lack of association between hyperglycaemia at arrival and clinical outcomes in acute stroke patients treated with tissue plasminogen activator.
BACKGROUND
Hyperglycaemia is associated with adverse outcomes in some studies of acute ischaemic stroke.


OBJECTIVE
We hypothesised that in thrombolytic-treated stroke patients, hyperglycaemia would be independently associated with haemorrhagic transformation and unfavourable outcome.


METHODS
Consecutive rt-PA-treated acute ischaemic stroke patients presenting to four emergency departments were analysed. Associations of initial blood glucose and survival to hospital discharge, symptomatic intracerebral haemorrhage, any form of intracerebral haemorrhage, and disability at hospital discharge were determined. Potentially confounding factors of age, National Institutes of Health Stroke Scale, and smoking were analysed by univariate logistic regression and those with P<0.3 included in the multivariate model.


RESULTS
In 268 patients, initial glucose values ranged from 62 to 507 mg/dl (mean 131). Elevated glucose at arrival was not significantly associated with any adverse clinical outcomes. A trend towards higher mortality in hyperglycaemic patients (odds ratio 1.71 per 100 mg/dl increase in glucose, 95% confidence interval 0.92-3.13, P=0.08) was seen, but is of unclear significance, and was not corroborated by effects on discharge disability, symptomatic intracerebral haemorrhage or intracerebral haemorrhage.


CONCLUSIONS
Thrombolytic-treated stroke patients with hyperglycaemia at presentation did not have significantly worse outcomes than others in this cohort. These data fail to confirm previously described associations seen in similarly sized studies. Further study of these associations and their magnitude are necessary to better define the relationship between serum glucose and outcome in thrombolytic-treated acute ischaemic stroke.
Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA. wmeurer@umich.edu
William J
WJ
Meurer
Phillip A
PA
Scott
Angela F
AF
Caveney
Jennifer J
JJ
Majersik
Shirley M
SM
Frederiksen
Annette
A
Sandretto
Ann B
AB
Holden
Robert
R
Silbergleit
D000208:Acute Disease; D001786:Blood Glucose / Q000378:metabolism; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000401:mortality; D004185:Disability Evaluation; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications* / Q000401:mortality; D016017:Odds Ratio; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000188:drug therapy* / Q000401:mortality; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D001786:Blood Glucose; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator