Association of admission blood glucose and outcome in patients treated with intravenous thrombolysis: results from the Safe Implementation of Treatments in Stroke International Stroke Thrombolysis Register (SITS-ISTR).
OBJECTIVE
To determine the association between admission blood glucose and outcome in ischemic stroke patients treated with thrombolysis.


METHODS
A prospective, open, multinational, observational study.


METHODS
An ongoing Internet-based, academic-driven, interactive thrombolysis register.


METHODS
Between 2002 and 2007, 16 049 patients were recorded in the SITS-ISTR.


METHODS
Blood glucose was recorded at admission. Blood glucose was divided into the following categories: less than 80, 80-120 (reference range), 121-140, 141-160, 161-180, 181-200, and greater than 200 mg/dL. Outcomes were mortality and independence (modified Rankin Scale score of 0-2) at 3 months and symptomatic intracerebral hemorrhage (SICH) (National Institutes of Health Stroke Scale deterioration ≥4 points within 24 hours and type 2 parenchymal hemorrhage).


RESULTS
In multivariable analysis, blood glucose as a continuous variable was independently associated with a higher mortality (P < .001), lower independence (P < .001), and an increased risk of SICH (P = .005). Blood glucose greater than 120 mg/dL as a categorical variable was associated with a significantly higher odds for mortality (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.07-1.44; P = .004) and a lower odds for independence (OR, 0.58; 95% CI, 0.48-0.70; P < .001), and blood glucose from 181 to 200 mg/dL was associated with an increased risk of SICH (OR, 2.86; 95% CI, 1.69-4.83; P < .001) compared with the reference level. The trends of associations between blood glucose and outcomes were similar in patients with diabetes (17%) or without such history, except for mortality (P = .23) and SICH (P = .06) in which the association was not statistically significant in patients with diabetes.


CONCLUSIONS
Admission hyperglycemia was an independent predictor for poor outcome after stroke/thrombolysis, though SICH rates did not increase significantly until reaching 180 mg/dL. These results suggest that tight control of blood glucose may be indicated in the hyperacute phase following thrombolysis. Randomized trial data are needed.
Ahmed
Niaz
N
Karolinska Stroke Research Unit, Department of Neurology, Karolinska University Hospital-Solna, Stockholm, Sweden. niaz.ahmed@karolinska.se
Dávalos
Antoni
A
Eriksson
Niclas
N
Ford
Gary A
GA
Glahn
Joerg
J
Hennerici
Michael
M
Mikulik
Robert
R
Kaste
Markku
M
Lees
Kennedy R
KR
Lindsberg
Perttu J
PJ
Toni
Danilo
D
D001786:Blood Glucose; D002545:Brain Ischemia / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis; D007275:Injections, Intravenous; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D020521:Stroke / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome
D001786:Blood Glucose