Hyperglycemia during Ischemia Rapidly Accelerates Brain Damage in Stroke Patients Treated with tPA

Ribó, Marc; Molina, Carlos A.; Delgado, Pilar; Rubiera, Marta; Delgado‐Mederos, Raquel; Rovira, Àlex; Munuera, Josep; Alvarez-Sabin, José

doi:10.1038/sj.jcbfm.9600460

Cited by 97 publications

(84 citation statements)

References 29 publications

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“…Baird et al1 examined blood glucose levels using the CGM in 25 patients with anterior circulation stroke syndrome; only mean blood glucose level was measured as a glucose parameter to examine its relationship to poor outcomes. Ribo et al22 showed that the longer duration of blood glucose ≥140 mg/dL on the CGM and the longer time to middle cerebral artery recanalization after intravenous thrombolysis were related to unfavorable outcomes at 3 months in 47 ischemic stroke patients. Shimoyama et al23 indicated that mean glucose level, large area under the curve >140 mg/dL, and SD on the CGM were associated with infarct volume growth in 78 ischemic stroke patients with internal carotid artery or middle cerebral artery occlusion.…”

Section: Discussionmentioning

confidence: 99%

Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring

Wada

Yoshimura

Inoue

et al. 2018

JAHA

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BackgroundThe purpose of this study was to examine the relationships between glucose parameters obtained by continuous glucose monitoring and clinical outcomes in acute stroke patients.Methods and ResultsConsecutive patients with acute ischemic stroke or intracerebral hemorrhage within 24 hours after onset were included. A continuous glucose monitoring device (iPro2) was attached for the initial 72 hours after emergent admission. Eight glucose parameters were obtained from continuous glucose monitoring: maximum, minimum, mean, and SD of blood glucose levels, as well as area under the curve more than 8 mmol/L of blood glucose, distribution time more than 8 mmol/L of blood glucose, coefficient of variation (%CV), and presence of time less than 4 mmol/L over 72 hours. The primary outcome measure was death or dependency at 3 months (modified Rankin Scale score ≥3). One hundred patients with acute ischemic stroke (n=58) or intracerebral hemorrhage (n=42) were included. Blood glucose levels varied between 5.2±1.4 and 11.4±3.2 mmol/L over 72 hours, with area under the curve more than 8 mmol/L of blood glucose of 0.7±1.4 min×mmol/L, distribution time more than 8 mmol/L of blood glucose of 31.7±32.7%, coefficient of variation of 15.5±5.4%, and presence of hypoglycemia in 20% of overall patients. Mean glucose level (adjusted odds ratio, 1.60, 95% confidence interval, 1.12–2.28/1 mmol/L), area under the curve more than 8 mmol/L of blood glucose (2.13, 1.12–4.02/1 min×mmol/L), and distribution time more than 8 mmol/L of blood glucose (1.25, 1.05–1.50/10%) were related to death or dependency for overall patients, as well as for acute ischemic stroke patients (2.05, 1.15–3.65; 2.38, 1.04–5.44; 1.85, 1.10–3.10, respectively).ConclusionsHigh mean glucose levels, distribution time more than 8 mmol/L of blood glucose, and areas under the curve more than 8 mmol/L of blood glucose during the initial 72 hours of acute stroke were associated with death or dependency at 3 months.

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Section: Discussionmentioning

confidence: 99%

Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring

Wada

Yoshimura

Inoue

et al. 2018

JAHA

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“…Possible causality is supported by experimental studies that have shown that HG worsened the conversion of penumbra into infarction [5][6][7] and exacerbated reperfusion injury. 5 In addition, 1 transcranial Doppler study suggested that HG may facilitate reperfusion injury in humans, 8 and carefully designed perfusion-diffusion studies [9][10][11] have reported that HG worsened the conversion of penumbra into infarction in a small series of patients. Penumbra in acute stroke is usually investigated by using by the diffusion-perfusion mismatch, which requires a contrast agent injection.…”

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confidence: 99%

Hyperglycemia and the Fate of Apparent Diffusion Coefficient–Defined Ischemic Penumbra

Rosso¹,

Attal²,

Deltour³

et al. 2011

AJNR Am J Neuroradiol

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“…This outcome is consistent with studies showing that mean admission blood glucose is higher in non-survivors of stroke than survivors. [27][28][29][30] Furthermore, another study showed that an admission blood glucose of 8 mmol/L or greater was an independent predictor of death, symptomatic intracranial haemorrhage and poor functional status at 90 days in thrombolysed patients. 31 Of patients with an admission glucose of less than 8 mmol/L, 40% had an excellent functional outcome, compared with 27.7% of those with a glucose of greater than 8 mmol/L.…”

Section: Animal Studies: Stroke Hyperglycaemia and Reperfusion Injurymentioning

confidence: 99%

“…[26][27][28] Recently, these findings have been supported by an imaging study. 29 The authors used transcranial Doppler, MRI, and magnetic resonance spectroscopy to show that hyperglycaemia is a strong predictor of infarct growth and poor outcome. The study had a small sample size of only 47 patients but showed that the stroke lesion on diffusion weighted imaging grew 2.7 times faster in patients with hyperglycaemia treated with tissue plasminogen activator than in those without.…”

Section: Animal Studies: Stroke Hyperglycaemia and Reperfusion Injurymentioning

confidence: 99%

Stroke and diabetes: a dangerous liaison

et al. 2016

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Ischaemic stroke is a major cause of disability and death and the incidence rate of ischaemic stroke is doubled in patients who have diabetes. Admission hyperglycaemia in acute stroke patients is associated with higher mortality, longer hospital stay and worse functional outcome. However, it remains unclear whether hyperglycaemia is in fact a marker of stroke severity or whether hyperglycaemia directly contributes to brain damage. Potential mechanisms of hyperglycaemia related brain damage in stroke include acidosis, oxidative stress and reperfusion injury. Evidence suggests a potential benefit of treatment of hyperglycaemia with insulin in acute stroke patients but the potential for morbidity caused hypoglycaemia should be considered. The American Heart Association/American Stroke Association guidelines recommend maintaining the blood glucose level in the range 7.8-10 mmol/L during acute stroke hospitalisation whilst the European Stroke Organization guideline recommends lowering the blood glucose with insulin to below 10 mmol/L. More research is needed to explore the impact of admission hyperglycaemia and hypoglycaemia on stroke outcomes and the role of other glucose lowering therapies. Br J Diabetes 2016;16:114-118

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Hyperglycemia during Ischemia Rapidly Accelerates Brain Damage in Stroke Patients Treated with tPA

Cited by 97 publications

References 29 publications

Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring

Outcome Prediction in Acute Stroke Patients by Continuous Glucose Monitoring

Hyperglycemia and the Fate of Apparent Diffusion Coefficient–Defined Ischemic Penumbra

Stroke and diabetes: a dangerous liaison

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