title: Post-thrombolytic hyperglycemia and 3-month outcome in acute ischemic stroke.
abstract: BACKGROUND
  Treating hyperglycemia in acute ischemic stroke may be beneficial, but knowledge on its prognostic value and optimal target glucose levels is scarce. We investigated the dynamics of glucose levels and the association of hyperglycemia with outcomes on admission and within 48 h after thrombolysis.
  
  
  METHODS
  We included 851 consecutive patients with acute ischemic stroke treated with intravenous thrombolysis in the Helsinki University Central Hospital during 1998-2008. Outcome measures were unfavorable 3- month outcome (3-6 on the modified Rankin Scale), death, and symptomatic intracerebral hemorrhage (sICH) according to NINDS criteria. Hyperglycemia was defined as a blood glucose level of ≥8.0 mmol/l. Four groups were identified based on (a) admission and (b) peak glucose levels 48 h after thrombolysis: (1) persistent normoglycemia (baseline plus 48-hour normoglycemia), (2) baseline hyperglycemia (48-hour normoglycemia), (3) 48-hour hyperglycemia (baseline normoglycemia), and (4) persistent hyperglycemia (baseline plus 48-hour hyperglycemia).
  
  
  RESULTS
  480 (56.4%) of our patients (median age 70 years; onset-to-needle time 199 min; National Institutes of Health Stroke Scale score 9), had persistent normoglycemia, 59 (6.9%) had baseline hyperglycemia, 175 (20.6%) had 48-hour hyperglycemia, while persistent hyperglycemia appeared in 137 (16.1%) patients. Persistent and 48-hour hyperglycemia independently predicted unfavorable outcome [odds ratio (OR) = 2.33, 95% confidence interval (CI) = 1.41-3.86, and OR = 2.17, 95% CI = 1.30-3.38, respectively], death (OR = 6.63, 95% CI = 3.25-13.54, and OR = 3.13, 95% CI = 1.56-6.27, respectively), and sICH (OR = 3.02, 95% CI = 1.68-5.43, and OR = 1.89, 95% CI = 1.04-3.43, respectively), whereas baseline hyperglycemia did not.
  
  
  CONCLUSIONS
  Hyperglycemia (≥8.0 mmol/l) during 48 h after intravenous thrombolysis of ischemic stroke is strongly associated with unfavorable outcome, sICH, and death.
authors.affiliation: Molecular Neurology Research Program, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 4, Helsinki, Finland. jukka.putaala@hus.fi
authors.forename: Jukka
authors.initials: J
authors.lastname: Putaala
authors.forename: Tiina
authors.initials: T
authors.lastname: Sairanen
authors.forename: Atte
authors.initials: A
authors.lastname: Meretoja
authors.forename: Perttu J
authors.initials: PJ
authors.lastname: Lindsberg
authors.forename: Marjaana
authors.initials: M
authors.lastname: Tiainen
authors.forename: Ron
authors.initials: R
authors.lastname: Liebkind
authors.forename: Daniel
authors.initials: D
authors.lastname: Strbian
authors.forename: Sari
authors.initials: S
authors.lastname: Atula
authors.forename: Ville
authors.initials: V
authors.lastname: Artto
authors.forename: Kirsi
authors.initials: K
authors.lastname: Rantanen
authors.forename: Pyry
authors.initials: P
authors.lastname: Silvonen
authors.forename: Katja
authors.initials: K
authors.lastname: Piironen
authors.forename: Sami
authors.initials: S
authors.lastname: Curtze
authors.forename: Olli
authors.initials: O
authors.lastname: Häppölä
authors.forename: Satu
authors.initials: S
authors.lastname: Mustanoja
authors.forename: Janne
authors.initials: J
authors.lastname: Pitkäniemi
authors.forename: Oili
authors.initials: O
authors.lastname: Salonen
authors.forename: Heli
authors.initials: H
authors.lastname: Silvennoinen
authors.forename: Lauri
authors.initials: L
authors.lastname: Soinne
authors.forename: Markku
authors.initials: M
authors.lastname: Kuisma
authors.forename: Turgut
authors.initials: T
authors.lastname: Tatlisumak
authors.forename: Markku
authors.initials: M
authors.lastname: Kaste
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D002545:Brain Ischemia / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005387:Finland; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D020300:Intracranial Hemorrhages / Q000139:chemically induced; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D005343:Fibrinolytic Agents; D007004:Hypoglycemic Agents