In-hospital dynamics of glucose, blood pressure and temperature predict outcome in patients with acute ischaemic stroke

Abstract

Introduction: We aimed to assess alterations in glucose, blood pressure and temperature in acute ischaemic stroke and investigate their association with early all-cause mortality and functional outcome. Patients and methods: We studied all consecutive acute ischaemic stroke patients admitted in 2001-2010 to the Acute Stroke Unit, at Alexandra University Hospital, in Athens. Serial measurements were performed in the first seven days post-stroke and different parameters have been estimated: mean daily values, variability, subject-specific baseline levels and rate of change in serial measurements. Cox-proportional-hazards-model analysis and logistic-regression analysis were applied to investigate the association between these parameters and all-cause mortality and functional outcome after adjustment for known confounders of stroke outcome. Results: In 1271 patients (mean age 72.3 AE 11.2 years), after adjusting for confounders, baseline glucose levels (HR: 1.005, 95%CI: 1.001-1.01; p ¼ 0.017), variability of systolic BP (SBP) as estimated by standard deviation (HR: 1.028, 95% CI: 1.01-1.048; p ¼ 0.005), the baseline temperature (HR: 2.758, 95%CI: 2.067-3.68; p < 0.001) and the rate of temperature change (HR: 1.841, 95%CI: 1.616-2.908; p < 0.001) were independently associated with all-cause mortality within three months. Poor functional outcome was associated with subject-specific baseline values of temperature (OR: 1.743; 95%CI: 1.076-2.825; p ¼ 0.024), the rate of SBP (OR: 1.159; 95% CI: 1.047-1.280; p ¼ 0.004) and temperature change (OR: 1.402; 95% CI: 1.061-1.853; p ¼ 0.018). Discussion: The main strength of our study is that we analysed simultaneously three parameters and we used four different variables for each parameter of interest. Conclusion: Baseline glucose levels, variability of SBP and baseline temperature and its rate of change are independent predictors of all-cause mortality. Baseline values of temperature and the rate of changes in SBP and temperature are independent predictors of poor functional outcome.

Machine learning-based prognostication of mortality in stroke patients

“…Likewise, the BP recorded upon admission to the emergency department has emerged as a predictive factor for stroke mortality [ 69 , 72 , 73 ]. While certain previous studies suggest that SBP can independently predict stroke mortality, with DBP holding less significance [ 69 ], other researchers have indicated that DBP plays a more notable role, particularly in specific contexts such as in hypertensive patients [ 73 ], or even acts as an independent predictor [ 74 ].…”

24-hour blood pressure variability and treatment effect of intravenous alteplase in acute ischaemic stroke

“…In contrast, in previous studies BPV measured by the standard deviation (SD) showed such an association. 7,22 This discrepancy illustrates the importance of the parameter chosen for measurement of BPV. Findings of an association of SD with outcome of stroke thrombolysis need to be interpreted with caution, as SD is strongly correlated with the mean BP, which was associated with outcome after thrombolysis in our study as well as in previous reports.…”

“…In contrast, in previous studies BPV measured by the standard deviation (SD) showed such an association. 7,22 This discrepancy illustrates the importance of the parameter chosen for measurement of BPV. Findings of an association of SD with outcome of Figure 1.…”