Persistent hyperglycemia >155 mg/dL in acute ischemic stroke patients: how well are we correcting it?: implications for outcome.
OBJECTIVE
We aimed to analyze the frequency of persistent hyperglycemia (PH), its implications for outcome, and to document the inpatient management of hyperglycemia.


METHODS
Post hoc analysis of the GLIAS (Glycemia in Acute Stroke) study, a multicenter, prospective, and observational cohort study of 476 acute ischemic stroke patients. Capillary finger-prick glucose was determined on admission and during the first 48 hours. We defined PH was defined as at least 2 values ≥155 mg/dL. Outcome (modified Rankin Scale) was evaluated at 3 months.


RESULTS
PH developed in 117 patients (24.7%). PH was associated with poorer outcome (modified Rankin Scale score >2: 56.2% vs 28.1%; P<0.01) and higher mortality (26.7% vs 5.9%; P<0.01) than those with glycemia <155 mg/dL. PH ≥155 mg/dL was associated with a 4-fold increase in the odds of poor outcome at 3 months (odds ratio, 4.7; 95% confidence interval, 2.2-10.2) after adjustment for age, gender, hypertension, diabetes, stroke severity, admission glycemia, and infarct volume. Only 20% of patients with hyperglycemia ≥155 mg/dL received insulin on admission, with a progressive increase in the use of insulin during the following 48 hours. However, 114 (39.1%) out of 291 patients who received corrective treatment for hyperglycemia still had levels ≥155 mg/dL.


CONCLUSIONS
PH ≥155 mg/dL is a common observation in acute ischemic stroke patients that is associated with poorer outcome and higher mortality. Almost 40% of patients maintained levels ≥155 mg/dL despite corrective treatment.
Fuentes
Blanca
B
Stroke Center, Department of Neurology, University Hospital La Paz, Madrid Autónoma University, IdiPAZ, Paseo de la Castellana 261, 28046 Madrid, Spain.
Ortega-Casarrubios
Maria Angeles
MA
Sanjosé
Belén
B
Castillo
José
J
Leira
Rogelio
R
Serena
Joaquín
J
Vivancos
José
J
Dávalos
Antonio
A
Gil-Nuñez
Antonio
A
Egido
José
J
Díez-Tejedor
Exuperio
E
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications*; D016896:Treatment Outcome
D007004:Hypoglycemic Agents