Dynamic of Hyperglycemia as a Predictor of Stroke Outcome in the ECASS-II Trial

Mei, Yong; Kaste, Markku

doi:10.1161/strokeaha.108.514307

Cited by 193 publications

(176 citation statements)

References 37 publications

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“…2 In addition, a post hoc analysis of ECASS II also suggested the higher prognostic value of hyperglycemia dynamics as opposed to a single glucose measurement. 3 Our study shows the deleterious effect of PH over isolated hyperglycemia. Because there is heterogeneity between studies in the definition of PH, and because our definition was arbitrary, although based on the results of a multicenter observational study, a prospective evaluation of the concept of PH is needed.…”

Section: Discussionmentioning

confidence: 56%

Persistent Hyperglycemia >155 mg/dL in Acute Ischemic Stroke Patients: How Well Are We Correcting It?

Fuentes¹,

Ortega-Casarrubios²,

San-José³

et al. 2010

Stroke

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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 Ն155 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 Ͼ2: 56.2% vs 28.1%; PϽ0.01) and higher mortality (26.7% vs 5.9%; PϽ0.01) than those with glycemia Ͻ155 mg/dL. PH Ն155 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 Ն155 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 Ն155 mg/dL. Conclusions-PH Ն155 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 Ն155 mg/dL despite corrective treatment. (Stroke. 2010;41:2362-2365.)

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Section: Discussionmentioning

confidence: 56%

Persistent Hyperglycemia >155 mg/dL in Acute Ischemic Stroke Patients: How Well Are We Correcting It?

Fuentes¹,

Ortega-Casarrubios²,

San-José³

et al. 2010

Stroke

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“…Diabetes (type 1 & 2) or acute hyperglycemia is evident in 25% (66) and 40% (67) of stroke patients respectively, and both are associated with poor outcome (68)(69)(70)(71).…”

Section: Hypertensionmentioning

confidence: 99%

Modeling Risk Factors and Confounding Effects in Stroke

2016

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Most research to date has used experimental models in rodents which fail to mimic the underlying causes of stroke in patients or the primary confounding factors. Available data indicate that factors such as atherosclerosis, hypertension, obesity, diabetes, age, and inflammation have a major influence on outcome. These findings suggest that we need to rethink the preclinical data that are required before selection of candidate interventions for clinical trials in stroke.

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“…Blood glucoses are initially elevated and then begin to decline in the first day after the acute stroke [31], but the blood glucoses will rise again generally after the first 24 to 88 h, irrespective of whether the patient had known diabetes [32]. There are numerous potential reasons for the occurrence of poststroke hyperglycemia.…”

Section: Hyperglycemia In the Stroke Patientmentioning

confidence: 99%

Care of the Stroke Patient: Routine Management to Lifesaving Treatment Options

2011

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The management of the acute ischemic stroke patient spans the time course from the emergency evaluation and treatment period through to the eventual discharge planning phase of stroke care. In this article we evaluate the literature and describe what have become standard treatments in the care of the stroke patient. We will review the literature that supports the use of a dedicated stroke unit for routine stroke care which has demonstrated reduced rates of morbidity and mortality. Also reviewed is the use of glycemic control in the initial setting along with data supporting the use of prophylactic treatments options in order to aide in the prevention of life threatening medical complications. In addition, lifesaving treatments will be discussed in light of new literature demonstrating reduced mortality in large hemispheric stroke patients undergoing surgical decompressive surgery. Both medical and surgical treatment options are discussed and compared.

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Dynamic of Hyperglycemia as a Predictor of Stroke Outcome in the ECASS-II Trial

Cited by 193 publications

References 37 publications

Persistent Hyperglycemia >155 mg/dL in Acute Ischemic Stroke Patients: How Well Are We Correcting It?

Persistent Hyperglycemia >155 mg/dL in Acute Ischemic Stroke Patients: How Well Are We Correcting It?

Modeling Risk Factors and Confounding Effects in Stroke

Care of the Stroke Patient: Routine Management to Lifesaving Treatment Options

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