Effect of Acute Glycaemic Index on Clinical Outcome after Acute Stroke

Abstract

Studies have shown that hyperglycaemia acutely after stroke independently predicts poorer survival and independence. Whether the change in glycaemic index in the acute phase of stroke has any effect on stroke outcome is unclear. Glycated serum proteins (GSP) reflect blood glucose concentration during the preceding 2 weeks. The aim of this study is to measure the association between the change in GSP % in the first 2 weeks after stroke and outcome. 167 patients were included. 117 (70%) patients were alive at 3 months. Admission glucose was higher in dead patients (7.8 mmol/l) compared to survivors (6.6 mmol/l) (p < 0.01). GSP at day 14 was higher in non survivors (21.8%) compared with survivors (19.1%) (p < 0.0001) as was the change in GSP (2.0 %) in non survivors compared with survivors (0.1%) (p < 0.0001). After adjusting for case mix, the change in GSP % was significantly associated with stroke mortality (p = 0.04). The odds ratio for death at 3 months after stroke associated with every 1% increase in change between GSP day 14 and GSP day 0, was 1.28 (95% CI: 1.1–1.62). Increases in glycaemic index as determined by GSP % are associated with excess in stroke mortality after adjusting for case mix. Intervention trials are required to test the hypothesis that improving glycaemic index after acute stroke improves outcome.

The effect of admission physiological variables on 30 day outcome after stroke

“…24,35 Indeed, a number of studies, including ours, have reported initially positive results with unadjusted analyses and negative results after adjustment. 3,8,29,30 Our predominantly negative findings may have been due to a relative lack of power. However, if statistically significant associations are only found in large cohorts, the magnitude of the effect is likely to be small.…”

Effect of hyperglycemia on progressive paraparesis in a rat metastatic spinal tumor model

“…Acute hyperglycemia following ischemic and traumatic brain injury has been shown to be associated with larger infarct volume and worse neurological outcome. 5,6,9,13,24,30,36,43,46,49 Elevated levels of advanced glycosylation end products, which quench vasodilators such as adenosine and nitric oxide, have been suggested to underlie this hyperglycemic effect. Nishikawa et al 31 identified 3 separate pathways of hyperglycemia-associated injury, all of which were blocked by limiting glucose-induced mitochondrial superoxide production.…”

Hyperglycemia independently increases the risk of perioperative stroke, myocardial infarction, and death after carotid endarterectomy. McGirt MJ, Woodworth GF, Brooke BS, et al. Neurosurgery. 2006;58:1066-1073

“…Previous data have demonstrated better outcomes in the intensive care and stroke patients with tight glycemic control. [1][2][3][4][5][6] These data suggest that identifying the hyperglycemic undergoing CEA may be useful. The authors suggest that regional blood flow compromise and small embolic events, although asymptomatic, may result in transient ischemic insults and that the hyperglycemia may affect the outcome via similar mechanisms in these patient populations.…”