Persistent hyperglycemia >155 mg/dL in acute ischemic stroke patients: how well are we correcting it?: implications for outcome.

Abstract

BACKGROUND AND PURPOSE:

We aimed to analyze the frequency of persistent hyperglycemia (PH), its implications for outcome, and to document the inpatient management of hyperglycemia.

METHODS:

Post hoc analysis of the GLIAS (Glycemia in Acute Stroke) study, a multicenter, prospective, and observational cohort study of 476 acute ischemic stroke patients. Capillary finger-prick glucose was determined on admission and during the first 48 hours. We defined PH was defined as at least 2 values ≥155 mg/dL. Outcome (modified Rankin Scale) was evaluated at 3 months.

RESULTS:

PH developed in 117 patients (24.7%). PH was associated with poorer outcome (modified Rankin Scale score >2: 56.2% vs 28.1%; P<0.01) and higher mortality (26.7% vs 5.9%; P<0.01) than those with glycemia <155 mg/dL. PH ≥155 mg/dL was associated with a 4-fold increase in the odds of poor outcome at 3 months (odds ratio, 4.7; 95% confidence interval, 2.2-10.2) after adjustment for age, gender, hypertension, diabetes, stroke severity, admission glycemia, and infarct volume. Only 20% of patients with hyperglycemia ≥155 mg/dL received insulin on admission, with a progressive increase in the use of insulin during the following 48 hours. However, 114 (39.1%) out of 291 patients who received corrective treatment for hyperglycemia still had levels ≥155 mg/dL.

CONCLUSIONS:

PH ≥155 mg/dL is a common observation in acute ischemic stroke patients that is associated with poorer outcome and higher mortality. Almost 40% of patients maintained levels ≥155 mg/dL despite corrective treatment.

• Authors: Blanca Fuentes, Maria Angeles Ortega-Casarrubios, Belén Sanjosé, José Castillo, Rogelio Leira, Joaquín Serena, José Vivancos, Antonio Dávalos, Antonio Gil-Nuñez, José Egido, Exuperio Díez-Tejedor, Stroke Project of the Cerebrovascular Diseases Study Group Spanish Society of Neurology
• Journal: Stroke (Stroke) Vol. 41 Issue 10 Pg. 2362-5 (Oct 2010) ISSN: 1524-4628 [Electronic] United States
• PMID: 20724713 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Hypoglycemic Agents

Topics

• Aged
• Aged, 80 and over
• Brain Ischemia (complications)
• Chi-Square Distribution
• Female
• Humans
• Hyperglycemia (complications, drug therapy)
• Hypoglycemic Agents (therapeutic use)
• Male
• Middle Aged
• Severity of Illness Index
• Stroke (complications)
• Treatment Outcome