title: Persistent hyperglycemia at 24-48 h in acute hyperglycemic stroke patients is not associated with a worse functional outcome.
abstract: BACKGROUND
  Recently, it was shown that the relation between admission glucose and functional outcome after ischemic stroke is described by a J-shaped curve, with a glucose range of 3.7-7.3 mmol/l associated with a favorable outcome. We tested the hypothesis that persistence of hyperglycemia above this threshold at 24-48 h after stroke onset impairs 3-month functional outcome.
  
  
  METHODS
  We analyzed all patients with glucose >7.3 mmol/l on admission from the Acute STroke Registry and Analysis of Lausanne (ASTRAL). Patients were divided into two groups according to their subacute glucose level at 24-48 h after last well-being time (group 1: ≤7.3 mmol/l, group 2: >7.3 mmol/l). A favorable functional outcome was defined as a modified Rankin Score (mRS) ≤2 at 3 months. A multiple logistic regression analysis of multiple demographic, clinical, laboratory and neuroimaging covariates was performed to assess predictors of an unfavorable outcome.
  
  
  RESULTS
  A total of 1,984 patients with ischemic stroke were admitted between January 1, 2003 and October 20, 2009, within 24 h after last well-being time. In the 421 patients (21.2%) with admission glucose >7.3 mmol/l, the proportion of patients with a favorable outcome was not statistically significantly different between the two groups (59.2 vs. 48.7%, respectively). In multiple logistic regression analysis, unfavorable outcome was significantly associated with age (odds ratio, OR: 1.06, 95% confidence interval, 95% CI: 1.03-1.08 for every 10-year increase), National Institute of Health Stroke Score, NIHSS score, on admission (OR: 1.16, 95% CI: 1.11-1.21), prehospital mRS (OR: 12.63, 95% CI: 2.61-61.10 for patients with score >0), antidiabetic drug usage (OR: 0.36, 95% CI: 0.15-0.86) and glucose on admission (OR: 1.16, 95% CI: 1.02-1.31 for every 1 mmol/l increase). No association was found between persistent hyperglycemia at 24-28 h and outcome in either diabetics or nondiabetics.
  
  
  CONCLUSIONS
  In ischemic stroke patients with acute hyperglycemia, persistent hyperglycemia (>7.3 mmol/l) at 24-48 h after stroke onset is not associated with a worse functional outcome at 3 months whether the patient was previously diabetic or not.
authors: Department of Neurology, Diabetes and Metabolism, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Rue du Bugnon 46, Lausanne, Switzerland. ntaiosgeorge@yahoo.gr
authors: G
authors: G
authors: Ntaios
authors: C
authors: C
authors: Abatzi
authors: M
authors: M
authors: Alexandrou
authors: D
authors: D
authors: Lambrou
authors: S
authors: S
authors: Chatzopoulos
authors: M
authors: M
authors: Egli
authors: J
authors: J
authors: Ruiz
authors: N
authors: N
authors: Bornstein
authors: P
authors: P
authors: Michel
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002545:Brain Ischemia / Q000150:complications; D016001:Confidence Intervals; D048909:Diabetes Complications / Q000628:therapy; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000628:therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D020766:Intracranial Embolism / Q000150:complications / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012042:Registries; D020521:Stroke / Q000150:complications* / Q000209:etiology / Q000628:therapy; D059409:Stroke, Lacunar / Q000150:complications / Q000628:therapy; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents