The effect of admission hyperglycemia in stroke patients treated with thrombolysis.
BACKGROUND
Acute hyperglycemia (HG) has been shown to correlate negatively with an outcome in stroke patients, yet the mechanism remains controversial. The aim of our study is to study the immediate and long-term effects of admission HG on outcome in a cohort of stroke patients treated with thrombolytic therapy.


METHODS
We reviewed the prospective dataset of a statewide telestroke network for the characteristics of 195 patients who received intravenous tissue plasminogen activator via telemedicine during a 27-month period. We compared outcome and improvement rate of patients with and without HG. We defined good outcome as a modified Rankin Scale score ≤ 2 and neurological improvement after thrombolysis as either a decrease in National Institutes of Health Stroke Scale (NIHSS) at 24 hr by 5 points from baseline or an NIHSS of 0 at 24 hr.


RESULTS
Thirty-one percent of patients had admission HG (Blood sugar > 144). Patients with admission HG had higher 3-month mortality and poor outcome rates than those without normoglycemia (NG). The improvement rates with thrombolysis, however, were similar between the two groups.


CONCLUSIONS
Admission HG is associated with poor neurological recovery in patients with an acute stroke despite thrombolytic treatment without having an effect on the clinical response to thrombolytic therapy. Larger studies are needed to confirm this finding.
Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. shadiyaghi@yahoo.com
Shadi
S
Yaghi
Archana
A
Hinduja
Nicolas
N
Bianchi
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D016208:Databases, Factual; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D006943:Hyperglycemia / Q000378:metabolism / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality*; D017216:Telemedicine; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
D001786:Blood Glucose; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator