Persistent Hyperglycemia at 24–48 h in Acute Hyperglycemic Stroke Patients Is Not Associated with a Worse Functional Outcome

Ntaios, George; Abatzi, C; Alexandrou, Maria Eleni; Lambrou, Dimitris; Chatzopoulos, S; Egli, Marc; Ruiz, Juan Carlos; Bornstein, Natan M.; Michel, Patrick

doi:10.1159/000331924

Cited by 25 publications

(13 citation statements)

References 42 publications

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“…Finally, hyperglycemia in the subacute phase seemed to be associated with unfavorable outcome at least as strongly as in the acute phase. This confirms previous observations of our group [50].…”

Section: Discussionsupporting

confidence: 94%

Severe stroke: patient profile and predictors of favorable outcome

Bill

Zufferey

Faouzi

et al. 2013

Journal of Thrombosis and Haemostasis

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Summary. Background: Severe stroke carries high rates of mortality and morbidity. The aims of this study were to determine the characteristics of patients who initially presented with severe ischemic stroke, and to identify acute and subacute predictors of favorable clinical outcome in these patients. Methods: An observational cohort study, Acute Stroke Registry and Analysis of Lausanne (ASTRAL), was analyzed, and all patients presenting with severe strokedefined as a National Institute of Health Stroke Scale score of ‡ 20 on admission -were compared with all other patients. In a multivariate analysis, associations with demographic, clinical, pathophysiologic, metabolic and neuroimaging factors were determined. Furthermore, we analyzed predictors of favorable outcome (modified Rankin scale score of £ 3 at 3 months) in the subgroup of severe stroke patients. Results: Of 1915 consecutive patients, 243 (12.7%) presented with severe stroke. This was significantly associated with cardio-embolic stroke mechanism (odds ratio [OR] 1.74, 95% confidence interval [CI] 1.19-2.54), unknown stroke onset (OR 2.35, 95% CI 1.14-4.83), more neuroimaging signs of early ischemia (mostly computed tomography; OR 2.65, 95% CI 1.79-3.92), arterial occlusions on acute imaging (OR 27.01, 95% CI 11.5-62.9), fewer chronic radiologic infarcts (OR 0.43, 95% CI 0.26-0.72), lower hemoglobin concentration (OR 0.97, 95% CI 0.96-0.99), and higher white cell count (OR 1.05, 95% CI 1.00-1.11). In the 68 (28%) patients with favorable outcomes despite presenting with severe stroke, this was predicted by lower age (OR 0.94, 95% CI 0.92-0.97), preceding cerebrovascular events (OR 3.00, 95% CI 1.01-8.97), hypolipemic pretreatment (OR 3.82, 95% CI 1.34-10.90), lower acute temperature (OR 0.43,, lower subacute glucose concentration (OR 0.74,, and spontaneous or treatment-induced recanalization (OR 4.51, 95% CI 1.96-10.41). Conclusions: Severe stroke presentation is predicted by multiple clinical, radiologic and metabolic variables, several of which are modifiable. Predictors in the 28% of patients with favorable outcome despite presenting with severe stroke include hypolipemic pretreatment, lower acute temperature, lower glucose levels at 24 h, and arterial recanalization.

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Section: Discussionsupporting

confidence: 94%

Severe stroke: patient profile and predictors of favorable outcome

Bill

Zufferey

Faouzi

et al. 2013

Journal of Thrombosis and Haemostasis

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“… 39 – 41 The utility and safety of dextrose administration in patients with large focal neurological deficits but mild, possibly non-contributory hypoglycemia may need to be evaluated in the future. Hyperglycemia can also present as a stroke mimic, and elevated blood glucose on admission correlates with worse outcomes after stroke, specifically infarct expansion, 42 – 48 and with intracranial hemorrhage after tPA. 49 , 50 …”

Section: Methodsmentioning

confidence: 99%

Acute Stroke: Current Evidence-based Recommendations for Prehospital Care

Glober

Sporer

Guluma

et al. 2016

WestJEM

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IntroductionIn the United States, emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with a suspected stroke and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California.MethodsWe performed a literature review of the current evidence in the prehospital treatment of a patient with a suspected stroke and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the stroke protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were the use of a stroke scale, blood glucose evaluation, use of supplemental oxygen, patient positioning, 12-lead electrocardiogram (ECG) and cardiac monitoring, fluid assessment and intravenous access, and stroke regionalization.ResultsProtocols across EMS agencies in California varied widely. Most used some sort of stroke scale with the majority using the Cincinnati Prehospital Stroke Scale (CPSS). All recommended the evaluation of blood glucose with the level for action ranging from 60 to 80mg/dL. Cardiac monitoring was recommended in 58% and 33% recommended an ECG. More than half required the direct transport to a primary stroke center and 88% recommended hospital notification.ConclusionProtocols for a patient with a suspected stroke vary widely across the state of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.

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“…In most research studies, a rise in blood sugar level in the setting of AIS has been associated with greater infarct size, symptomatic intracerebral haemorrhage and worse clinical outcome, [2][3][4]28,30,31 especially for patients without pre-existing diabetes. 4 A J-shaped association between serum glucose and functional outcome has been described in a recent study.…”

Section: Discussionmentioning

confidence: 99%

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

Skafida

Mitrakou

Georgiopoulos

et al. 2018

European Stroke Journal

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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.

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Persistent Hyperglycemia at 24–48 h in Acute Hyperglycemic Stroke Patients Is Not Associated with a Worse Functional Outcome

Cited by 25 publications

References 42 publications

Severe stroke: patient profile and predictors of favorable outcome

Severe stroke: patient profile and predictors of favorable outcome

Acute Stroke: Current Evidence-based Recommendations for Prehospital Care

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

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