title: Predictive value of admission blood glucose level on short-term mortality in acute cerebral ischemia.
abstract: BACKGROUND
  Admission hyperglycemia increases the risk of death in patients with acute stroke. However, the most appropriate cut-off of glucose level indicating an increased risk of short-term mortality remains unknown.
  
  
  OBJECTIVE
  We aimed at establishing the optimum cut-offs of several variables (including admission blood glucose levels) predicting case-fatality (72hours, 7days) and unfavorable outcome [modified Rankin Scale (mRS) score 5-6 at 7 days] in consecutive first-ever acute ischemic stroke. Receiver operating characteristic (ROC) curves were constructed.
  
  
  RESULTS
  Eight hundred eleven consecutive patients were included [median age of 77 (69-83) years; 418 (52%) male; 239 (30%) diabetics; median admission National Institutes of Health Stroke Scale (NIHSS) 7 (4-12), 32 (4%) dead within 72hours; 64 (8%) dead within day 7; 155 (19%) with unfavorable outcome]. Median admission glucose levels were 113 (97-155)mg/dL. Diabetics had significantly higher median glucose levels than non-diabetics [163 (133-214) vs. 107 (92-123) mg/dL, p<0.001]. According to ROC analysis, the only significant predictive value of glycemia was ≥143mg/dL for 72-hour fatality (sensitivity 88% and specificity 70%) especially in non-diabetics (sensitivity 88% and sensitivity 62%). This cut-off point was an independent predictor for 72-hour fatality (overall: OR=4.0, CI=1.6-9.9, p=0.003; non-diabetics: OR=4.9, CI=1.7-14.5, p=0.004). The cut-offs of fasting total cholesterol levels and admission leukocytes had poor predictive values for each outcome, while those of admission NIHSS had good discrimination in predicting short-term outcome measures.
  
  
  CONCLUSIONS
  Admission hyperglycemia (≥143mg/dL) is a strong and an independent predictor for 72-hour fatality, especially in patients with no prior history of diabetes mellitus.
authors.affiliation: Neurologic Clinic, University of Perugia, Perugia, Italy. katinardi@yahoo.it
authors.forename: Katiuscia
authors.initials: K
authors.lastname: Nardi
authors.forename: Paolo
authors.initials: P
authors.lastname: Milia
authors.forename: Paolo
authors.initials: P
authors.lastname: Eusebi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Paciaroni
authors.forename: Valeria
authors.initials: V
authors.lastname: Caso
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis*; D002545:Brain Ischemia / Q000097:blood* / Q000150:complications / Q000401:mortality*; D002784:Cholesterol / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007958:Leukocyte Count; D008297:Male; D010343:Patient Admission; D011237:Predictive Value of Tests; D012372:ROC Curve; D020521:Stroke / Q000097:blood* / Q000150:complications / Q000401:mortality*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D002784:Cholesterol