title: Admission hyperglycemia and outcome after intravenous thrombolysis: is there a difference among the stroke-subtypes?
abstract: BACKGROUND
  The prognostic influence of hyperglycemia in acute stroke has been well established. While in cortical stroke there is a strong association between hyperglycemia and poor outcome, this relation is less clear in lacunar stroke. It has been suggested that this discrepancy is present among patients treated with intravenous tissue plasminogen activator (tPA), but confirmation is needed.
  
  
  METHODS
  In two prospectively collected cohorts of patient treated with intravenous tPA for acute ischemic stroke, we investigated the effect of hyperglycemia (serum glucose level >8 mmol/L) on functional outcome in lacunar and non-lacunar stroke. Poor functional outcome was defined as modified Rankin Scale score ≥ 3 at 3 months.
  
  
  RESULTS
  A total of 1012 patients was included of which 162 patients (16%) had lacunar stroke. The prevalence of hyperglycemia did not differ between stroke subtypes (22% vs 21%, p = 0.85). In multivariate analysis hyperglycemia was associated with poor functional outcome in non-lacunar stroke (OR 2.1, 95% CI 1.39-3.28, p = 0.001). In patients with lacunar stroke, we did not find an association (OR 1.8, 95% CI 0.62-4.08, p = 0.43).
  
  
  CONCLUSIONS
  This study confirms a difference in prognostic influence of hyperglycemia between non-lacunar and lacunar ischemic stroke.
authors.affiliation: Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
authors.forename: Irene
authors.initials: I
authors.lastname: Miedema
authors.affiliation: Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
authors.forename: Gert-Jan
authors.initials: GJ
authors.lastname: Luijckx
authors.affiliation: Department of Neurology, Universitair Ziekenhuis Brussel, Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
authors.forename: Raf
authors.initials: R
authors.lastname: Brouns
authors.affiliation: Department of Neurology, Universitair Ziekenhuis Brussel, Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: De Keyser
authors.affiliation: Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands. m.uyttenboogaart@umcg.nl.
authors.forename: Maarten
authors.initials: M
authors.lastname: Uyttenboogaart
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D020521:Stroke / Q000150:complications / Q000188:drug therapy*; D059409:Stroke, Lacunar / Q000150:complications / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator
keywords: Acute ischemic stroke; Functional outcome; Hyperglycemia; Stroke subtype; Tissue plasminogen activator