Hyperglycemia is associated with more severe cytotoxic injury after stroke.
Hyperglycemia is a common complication after ischemic stroke, but its link to worse outcome is not well understood. We hypothesized that hyperglycemia may reflect an impaired metabolic response that is associated with worse cytotoxic brain injury. We performed retrospective analysis of magnetic resonance imaging from a cohort of acute ischemic stroke patients prospectively collected from 2006 to 2010 with baseline demographic and laboratory data as well as three-month outcomes. The severity of cytotoxic injury was quantified in vivo using apparent diffusion coefficient imaging by measuring the signal intensity within the stroke relative to the normal signal intensity of the contralateral hemisphere. Both hyperglycemia and lower apparent diffusion coefficient signal were associated with worse outcome after ischemic stroke (OR 0.239, p = 0.017; OR 1.11, p < 0.0001, respectively). Hyperglycemia was also associated with lower apparent diffusion coefficient (r = -0.32, p < 0.001). In multivariate analysis, apparent diffusion coefficient but not hyperglycemia was associated with outcome, suggesting that cytotoxicity may mediate the effect of hyperglycemia. For interventions designed to target hyperglycemia in acute ischemic stroke, a concomitant effect on the evolution of apparent diffusion coefficient may provide insight into whether hyperglycemia leads to or reflects worse cytotoxic injury.
1 Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Brigham and Women's Hospital, Boston, MA, USA.
Matthew B
MB
Bevers
2 Division of Neurocritical Care and Emergency Neurology, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA.
Neil H
NH
Vaishnav
2 Division of Neurocritical Care and Emergency Neurology, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA.
Ly
L
Pham
2 Division of Neurocritical Care and Emergency Neurology, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA.
Thomas Wk
TW
Battey
2 Division of Neurocritical Care and Emergency Neurology, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA.|3 J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA.
W Taylor
WT
Kimberly
D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000097:blood* / Q000209:etiology / Q000473:pathology; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology
D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
Acute stroke; brain imaging; brain ischemia; diffusion weighted MRI; hyperglycemia
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