title: Hyperglycemia predicts poststroke infections in acute ischemic stroke.
abstract: OBJECTIVE
  To investigate whether admission hyperglycemia predicts poststroke infections and, if so, whether poststroke infections modify the effect of admission hyperglycemia on functional outcome in ischemic stroke.
  
  
  METHODS
  We used data from acute ischemic stroke patients in the Preventive Antibiotics in Stroke Study (PASS), a multicenter randomized controlled trial (n = 2,550) investigating the effect of preventive antibiotics on functional outcome. Admission hyperglycemia was defined as blood glucose ≥7.8 mmol/L and poststroke infection as any infection during admission judged by an expert adjudication committee. Functional outcome at 3 months was assessed with the modified Rankin Scale.
  
  
  RESULTS
  Of 1,676 nondiabetic ischemic stroke patients, 338 (20%) had admission hyperglycemia. After adjustment for potential confounding variables, admission hyperglycemia was associated with poststroke infection (adjusted odds ratio [aOR] 2.31, 95% CI 1.31-4.07), worse 3-month functional outcome (common aOR 1.40, 95% CI 1.12-1.73), and 3-month mortality (aOR 2.11, 95% CI 1.40-3.19). Additional adjustment for poststroke infection in the functional outcome analysis, done to assess poststroke infection as an intermediate in the pathway from admission hyperglycemia to functional outcome, did not substantially change the model. In patients with recorded diabetes mellitus (n = 418), admission hyperglycemia was not associated with poststroke infection (aOR 0.49, 95% CI 0.15-1.58).
  
  
  CONCLUSIONS
  In nondiabetic acute ischemic stroke patients, admission hyperglycemia is associated with poststroke infection and worse functional outcome. Poststroke infections did not modify the effect of admission hyperglycemia on functional outcome in ischemic stroke.
authors.affiliation: From the Department of Neurology (T.P.Z., P.J.N., W.F.W., M.C.B., D.v.d.B.), Academic Medical Center, Amsterdam; and the Department of Neurology (N.D.K.), Leiden University Medical Center, the Netherlands.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Zonneveld
authors.affiliation: From the Department of Neurology (T.P.Z., P.J.N., W.F.W., M.C.B., D.v.d.B.), Academic Medical Center, Amsterdam; and the Department of Neurology (N.D.K.), Leiden University Medical Center, the Netherlands.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nederkoorn
authors.affiliation: From the Department of Neurology (T.P.Z., P.J.N., W.F.W., M.C.B., D.v.d.B.), Academic Medical Center, Amsterdam; and the Department of Neurology (N.D.K.), Leiden University Medical Center, the Netherlands.
authors.forename: Willeke F
authors.initials: WF
authors.lastname: Westendorp
authors.affiliation: From the Department of Neurology (T.P.Z., P.J.N., W.F.W., M.C.B., D.v.d.B.), Academic Medical Center, Amsterdam; and the Department of Neurology (N.D.K.), Leiden University Medical Center, the Netherlands.
authors.forename: Matthijs C
authors.initials: MC
authors.lastname: Brouwer
authors.affiliation: From the Department of Neurology (T.P.Z., P.J.N., W.F.W., M.C.B., D.v.d.B.), Academic Medical Center, Amsterdam; and the Department of Neurology (N.D.K.), Leiden University Medical Center, the Netherlands.
authors.forename: Diederik
authors.initials: D
authors.lastname: van de Beek
authors.affiliation: From the Department of Neurology (T.P.Z., P.J.N., W.F.W., M.C.B., D.v.d.B.), Academic Medical Center, Amsterdam; and the Department of Neurology (N.D.K.), Leiden University Medical Center, the Netherlands. ndkruyt@gmail.com.
authors.forename: Nyika D
authors.initials: ND
authors.lastname: Kruyt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism*; D002545:Brain Ischemia / Q000150:complications; D002443:Ceftriaxone / Q000627:therapeutic use; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000503:physiopathology*; D017053:Infection Control; D007239:Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D020521:Stroke / Q000150:complications* / Q000209:etiology / Q000401:mortality
chemical_list: D000900:Anti-Bacterial Agents; D001786:Blood Glucose; D002443:Ceftriaxone