Impaired fasting glucose is associated with unfavorable outcome in ischemic stroke patients treated with intravenous alteplase

  • E. Osei
  • S. Fonville
  • A. A. M. Zandbergen
  • P. J. Koudstaal
  • D. W. J. Dippel
  • H. M. den Hertog
Original Communication
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Abstract

Objectives

Hyperglycemia on admission and diabetes mellitus type II are associated with unfavorable outcome in stroke patients. We studied whether impaired fasting glucose (IFG) is associated with unfavorable outcome in ischemic stroke patients treated with intravenous alteplase as well and if IFG is a stronger prognostic factor than hyperglycemia on admission.

Methods

We studied 220 consecutive patients with ischemic stroke treated with intravenous alteplase. In all nondiabetic patients, fasting glucose was determined on day 2–5. IFG was defined as fasting glucose level of ≥ 5.6 mmol/L, hyperglycemia on admission as glucose levels ≥ 7.9 mmol/L. The primary effect measure was the adjusted common odds ratio (acOR) for a shift in the direction of worse outcome on the modified Rankin Scale at 3 months, estimated with ordinal logistic regression, and adjusted for common prognostic factors.

Results

The fasting glucose levels were available in 194 and admission glucose levels in 215 patients. Sixty-three (32.5%) had IFG, 58 (27%) hyperglycemia on admission and 32 (14.6%) pre-existent diabetes. Patients with IFG showed a shift towards worse functional outcome compared with patients with normal fasting glucose levels (acOR 2.77; 95% CI 1.54–4.97), which was stronger than hyperglycemia on admission (acOR 1.75; 95% CI 0.91–3.4).

Conclusions

IFG is associated with unfavorable outcome after treatment with intravenous alteplase for acute ischemic stroke. IFG predicts unfavorable outcome better than hyperglycemia on admission.

Keywords

Glucose Thrombolysis Hyperglycemia Stroke Outcome 

Notes

Compliance with ethical standards

Conflicts of interest

All authors state no conflict of interest.

Ethical standard

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • E. Osei
    • 1
  • S. Fonville
    • 2
  • A. A. M. Zandbergen
    • 3
  • P. J. Koudstaal
    • 3
  • D. W. J. Dippel
    • 3
  • H. M. den Hertog
    • 1
  1. 1.Medical Spectrum TwenteEnschedeThe Netherlands
  2. 2.University Medical Center UtrechtUtrechtThe Netherlands
  3. 3.Erasmus Medical CenterRotterdamThe Netherlands

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