Open AccessLack of association between hyperglycaemia at arrival and clinical outcomes in acute stroke patients treated with tissue plasminogen activator
Author(s) -
Meurer William J.,
Scott Phillip A.,
Caveney Angela F.,
Majersik Jennifer J.,
Frederiksen Shirley M.,
Sandretto Annette,
Holden Ann B.,
Silbergleit Robert
Publication year - 2010
Publication title -
international journal of stroke
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.375
H-Index - 74
eISSN - 1747-4949
pISSN - 1747-4930
DOI - 10.1111/j.1747-4949.2010.00425.x
Subject(s) - medicine , stroke (engine) , odds ratio , tissue plasminogen activator , intracerebral hemorrhage , confounding , confidence interval , thrombolysis , cohort , univariate analysis , logistic regression , fibrinolytic agent , cohort study , multivariate analysis , myocardial infarction , subarachnoid hemorrhage , mechanical engineering , engineering
Rationale Hyperglycaemia is associated with adverse outcomes in some studies of acute ischaemic stroke. Aims We hypothesised that in thrombolytic‐treated stroke patients, hyperglycaemia would be independently associated with haemorrhagic transformation and unfavourable outcome. Design Consecutive rt‐PA‐treated acute ischaemic stroke patients presenting to four emergency departments were analysed. Associations of initial blood glucose and survival to hospital discharge, symptomatic intracerebral haemorrhage, any form of intracerebral haemorrhage, and disability at hospital discharge were determined. Potentially confounding factors of age, National Institutes of Health Stroke Scale, and smoking were analysed by univariate logistic regression and those with P <0·3 included in the multivariate model. Study Outcome In 268 patients, initial glucose values ranged from 62 to 507 mg/dl (mean 131). Elevated glucose at arrival was not significantly associated with any adverse clinical outcomes. A trend towards higher mortality in hyperglycaemic patients (odds ratio 1·71 per 100 mg/dl increase in glucose, 95% confidence interval 0·92–3·13, P =0·08) was seen, but is of unclear significance, and was not corroborated by effects on discharge disability, symptomatic intracerebral haemorrhage or intracerebral haemorrhage. Conclusions Thrombolytic‐treated stroke patients with hyperglycaemia at presentation did not have significantly worse outcomes than others in this cohort. These data fail to confirm previously described associations seen in similarly sized studies. Further study of these associations and their magnitude are necessary to better define the relationship between serum glucose and outcome in thrombolytic‐treated acute ischaemic stroke.