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Hyperglycemia as An Independent Predictor of Worse Outcome in Non-diabetic Patients Presenting with Acute Ischemic Stroke

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Abstract

Objective

To determine if differences in outcome exist between diabetic and non-diabetic patients who present to the Emergency Department (ED) with acute ischemic stoke (AIS) and elevated blood glucose.

Methods

The study population consisted of 447 consecutive patients who presented to the ED with AIS within 24 h of symptom onset and had blood glucose measured on presentation. Hyperglycemia was defined as >130 mg/dl. Outcomes studied included infarct volume, stroke severity (NIH Stroke Scale), functional impairment (modified Rankin Score), and 90-day mortality. Patients with hyperglycemia were then stratified into those with and without a prior history of diabetes mellitus (DM) for the purposes of analysis.

Results

Patients with hyperglycemia exhibited significantly greater stroke severity (P = 0.002) and greater functional impairment (P = 0.004) than those with normoglycemia. Patients with hyperglycemia were 2.3 times more likely to be dead at 90 days compared to those with normal glucose (P < 0.001). Stroke severity (P < 0.001) and functional impairment (P < 0.001) were both significantly worse in patients with hyperglycemia and no prior history of DM, when compared to patients with hyperglycemia and previously diagnosed DM. Among the patients without a prior history of DM, patients with hyperglycemia were 3.4 times more likely to die within 90 days (P < 0.001) when compared with patients with normoglycemia. In contrast, the hazard ratio was 1.6 among the patients with DM (P = 0.66).

Conclusion

Hyperglycemia on presentation is associated with significantly poorer outcomes following AIS. Patients with hyperglycemia and no prior history of DM have a particularly poor prognosis, worse than that for patients with known diabetes and hyperglycemia.

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References

  1. Toni D, Sacchetti ML, Argentino C, Gentile M, Cavalletti C, Frontoni M, et al. Does hyperglycaemia play a role on the outcome of acute ischaemic stroke patients? J Neurol. 1992;239:382–6.

    PubMed  CAS  Google Scholar 

  2. Olsson T, Viitanen M, Asplund K, Eriksson S, Hagg E. Prognosis after stroke in diabetic patients. A controlled prospective study. Diabetologia. 1990;33:244–9.

    Article  PubMed  CAS  Google Scholar 

  3. Weir CJ, Murray GD, Dyker AG, Lees KR. Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long-term follow-up study. BMJ. 1997;314:1303–6.

    PubMed  CAS  Google Scholar 

  4. Williams LS, Rotich J, Qi R, Fineberg N, Espay A, Bruno A, et al. Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke. Neurology. 2002;59:67–71.

    PubMed  CAS  Google Scholar 

  5. Kasner SE, Chalela JA, Luciano JM, Cucchiara BL, Raps EC, McGarvey ML, et al. Reliability and validity of estimating the NIH stroke scale score from medical records. Stroke. 1999;30:1534–7.

    PubMed  CAS  Google Scholar 

  6. Williams LS, Yilmaz EY, Lopez-Yunez AM. Retrospective assessment of initial stroke severity with the NIH Stroke Scale. Stroke. 2000;31:858–62.

    PubMed  CAS  Google Scholar 

  7. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24:35–41.

    PubMed  Google Scholar 

  8. Rankin J. Cerebral vascular accidents in patients over age 60. Scott Med J. 1957;2:200–15.

    PubMed  CAS  Google Scholar 

  9. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81.

    Article  Google Scholar 

  10. Gilmore RM, Stead LG. The role of hyperglycemia in acute ischemic stroke. Neurocrit Care. 2006;5:153–8.

    Article  PubMed  Google Scholar 

  11. Myers RE, Yamaguchi S. Nervous system effects of cardiac arrest in monkeys. Preservation of vision. Arch Neurol. 1977;34:65–74.

    PubMed  CAS  Google Scholar 

  12. Pulsinelli WA, Waldman S, Rawlinson D, Plum F. Moderate hyperglycemia augments ischemic brain damage: a neuropathologic study in the rat. Neurology. 1982;32:1239–46.

    PubMed  CAS  Google Scholar 

  13. Lin B, Ginsberg MD, Busto R. Hyperglycemic exacerbation of neuronal damage following forebrain ischemia: microglial, astrocytic and endothelial alterations. Acta Neuropathol. 1998;96:610–20.

    Article  PubMed  CAS  Google Scholar 

  14. Hoxworth JM, Xu K, Zhou Y, Lust WD, LaManna JC. Cerebral metabolic profile, selective neuron loss, and survival of acute and chronic hyperglycemic rats following cardiac arrest and resuscitation. Brain Res. 1999;821:467–79.

    Article  PubMed  CAS  Google Scholar 

  15. Benveniste H. The excitotoxin hypothesis in relation to cerebral ischemia. Cerebrovasc Brain Metab Rev. 1991;3:213–45.

    PubMed  CAS  Google Scholar 

  16. Kawai N, Keep RF, Betz AL. Effects of hyperglycemia on cerebral blood flow and edema formation after carotid artery occlusion in Fischer 344 rats. Acta Neurochir Suppl. 1997;70:34–6.

    PubMed  CAS  Google Scholar 

  17. Parsons MW, Barber PA, Desmond PM, Baird TA, Darby DG, Byrnes G, et al. Acute hyperglycemia adversely affects stroke outcome: a magnetic resonance imaging and spectroscopy study. Ann Neurol. 2002;52:20–8.

    Article  PubMed  Google Scholar 

  18. Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke. 2001;32:2426–32.

    Article  PubMed  CAS  Google Scholar 

  19. Williams LS, Rotich J, Qi R, Fineberg N, Espay A, Bruno A, et al. Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke. Neurology. 2002;59:67–71.

    PubMed  CAS  Google Scholar 

  20. Adams HP Jr, Adams RJ, Brott T, del Zoppo GJ, Furlan A, Goldstein LB, et al. Stroke Council of the American Stroke Association. Guidelines for the early management of patients with ischemic stroke: a scientific statement from the Stroke Council of the American Stroke Association. Stroke. 2003;34:1056–83.

    Article  PubMed  Google Scholar 

  21. Hack W, Kaste M, Bogousslavsky J, Brainin M, Chamorro A, Lees K, et al. European Stroke Initiative Recommendations for Stroke Management—update 2003. Cerebrovasc Dis. 2003;16:311–37.

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Research, Generose G-410, Department of Emergency Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Latha G. Stead, Rachel M. Gilmore, M. Fernanda Bellolio, Shaily Mishra & Lekshmi Vaidyanathan

  2. Department of Internal Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Anjali Bhagra

  3. Department of Emergency Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Wyatt W. Decker

  4. Department of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Robert D. Brown Jr

Authors
  1. Latha G. Stead
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  2. Rachel M. Gilmore
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  3. M. Fernanda Bellolio
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  4. Shaily Mishra
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  5. Anjali Bhagra
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  6. Lekshmi Vaidyanathan
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  7. Wyatt W. Decker
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  8. Robert D. Brown Jr
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Corresponding author

Correspondence to Latha G. Stead.

Additional information

Ethics committee approval: The article is part of the project “Emergency Department Stroke Registry” with the Institutional Review Board approval number 1056-04.

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Stead, L.G., Gilmore, R.M., Bellolio, M.F. et al. Hyperglycemia as An Independent Predictor of Worse Outcome in Non-diabetic Patients Presenting with Acute Ischemic Stroke. Neurocrit Care 10, 181–186 (2009). https://doi.org/10.1007/s12028-008-9080-0

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  • DOI: https://doi.org/10.1007/s12028-008-9080-0

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