title: Admission hyperglycemia and outcomes in large vessel occlusion strokes treated with mechanical thrombectomy.
abstract: OBJECTIVE
  Higher admission serum glucose levels have been associated with poor outcomes in patients with acute ischemic stroke (AIS) treated with IV thrombolysis. We sought to evaluate the association of admission serum glucose with early outcomes of patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT).
  
  
  METHODS
  Consecutive AIS patients due to ELVO treated with MT in three tertiary stroke centers were evaluated. The following outcomes were documented using standard definitions: symptomatic intracranial hemorrhage (sICH), complete reperfusion, mortality, functional independence (modified Rankin Scale (mRS) score of 0-2), and functional improvement (shift in mRS score) at 3 months. The association of admission serum glucose and admission hyperglycemia (>140 mg/dL) with outcomes was evaluated using univariable and multivariable binary and ordinal logistic regression models.
  
  
  RESULTS
  231 AIS patients with ELVO (mean age 62±14 years, 51% men, median admission National Institute of Health Stroke Scale score 16 points (IQR 12-21), median admission serum glucose 125 mg/dL (IQR 104-162)) were treated with MT. Admission hyperglycemia was associated with a lower likelihood of functional improvement (common OR 0.53; 95% CI 0.31 to 0.97; p=0.027) and higher odds of 3 month mortality (OR 2.76; 95% CI 1.40 to 5.44; p=0.004) in multivariable analyses adjusting for potential confounders. A 10 mg/dL increase in admission blood glucose was associated with a higher likelihood of sICH (OR 1.07; 95% CI 1.01 to 1.13; p=0.033) and 3 month mortality (OR 1.07; 95% CI 1.02 to 1.12; p=0.004) in multivariable models. There was no association between admission serum glucose or hyperglycemia and complete reperfusion.
  
  
  CONCLUSIONS
  Higher admission serum glucose and admission hyperglycemia are independent predictors of adverse outcomes in ELVO patients treated with MT.
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Nitin
authors.initials: N
authors.lastname: Goyal
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.|Second Department of Neurology, 'Attikon University Hospital', School of Medicine, University of Athens, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsivgoulis
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Abhi
authors.initials: A
authors.lastname: Pandhi
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Kira
authors.initials: K
authors.lastname: Dillard
authors.affiliation: Second Department of Neurology, 'Attikon University Hospital', School of Medicine, University of Athens, Athens, Greece.|International Clinical Research Center, St Anne's Hospital, Brno, Czech Republic.
authors.forename: Aristeidis H
authors.initials: AH
authors.lastname: Katsanos
authors.affiliation: Acute Stroke Unit, Metropolitan Hospital, Piraeus, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Magoufis
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Chang
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Ramin
authors.initials: R
authors.lastname: Zand
authors.affiliation: Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hoit
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.|Acute Stroke Unit, Metropolitan Hospital, Piraeus, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Safouris
authors.affiliation: Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Asim
authors.initials: A
authors.lastname: Choudhri
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.|Australian Catholic University, Sydney, Australia.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Alexandrov
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Alexandrov
authors.affiliation: Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Arthur
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.|Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Lucas
authors.initials: L
authors.lastname: Elijovich
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002545:Brain Ischemia / Q000097:blood / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends*; D011446:Prospective Studies; D015424:Reperfusion / Q000009:adverse effects / Q000639:trends; D012189:Retrospective Studies; D020521:Stroke / Q000097:blood* / Q000401:mortality / Q000601:surgery*; D017131:Thrombectomy / Q000009:adverse effects / Q000639:trends*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose
keywords: Stroke; Thrombectomy