Hyperglycemia as an independent predictor of worse outcome in non-diabetic patients presenting with acute ischemic stroke

Latha G. Stead, Rachel M. Gilmore, Fernanda Bellolio, Shaily Mishra, Anjali Bhagra, Lekshmi Vaidyanathan, Wyatt W. Decker, Robert D Jr. Brown

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Objective: To determine if differences in outcome exist between diabetic and non-diabetic patients who present to the Emergency Department (ED) with acute ischemic stoke (AIS) and elevated blood glucose. Methods: The study population consisted of 447 consecutive patients who presented to the ED with AIS within 24 h of symptom onset and had blood glucose measured on presentation. Hyperglycemia was defined as >130 mg/dl. Outcomes studied included infarct volume, stroke severity (NIH Stroke Scale), functional impairment (modified Rankin Score), and 90-day mortality. Patients with hyperglycemia were then stratified into those with and without a prior history of diabetes mellitus (DM) for the purposes of analysis. Results: Patients with hyperglycemia exhibited significantly greater stroke severity (P = 0.002) and greater functional impairment (P = 0.004) than those with normoglycemia. Patients with hyperglycemia were 2.3 times more likely to be dead at 90 days compared to those with normal glucose (P < 0.001). Stroke severity (P < 0.001) and functional impairment (P < 0.001) were both significantly worse in patients with hyperglycemia and no prior history of DM, when compared to patients with hyperglycemia and previously diagnosed DM. Among the patients without a prior history of DM, patients with hyperglycemia were 3.4 times more likely to die within 90 days (P < 0.001) when compared with patients with normoglycemia. In contrast, the hazard ratio was 1.6 among the patients with DM (P = 0.66). Conclusion: Hyperglycemia on presentation is associated with significantly poorer outcomes following AIS. Patients with hyperglycemia and no prior history of DM have a particularly poor prognosis, worse than that for patients with known diabetes and hyperglycemia.

Original languageEnglish (US)
Pages (from-to)181-186
Number of pages6
JournalNeurocritical Care
Volume10
Issue number2
DOIs
StatePublished - Apr 2009

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Hyperglycemia
Stroke
Diabetes Mellitus
Blood Glucose
Hospital Emergency Service
Stroke Volume
Glucose

Keywords

  • Acute ischemic stroke
  • Diabetes mellitus
  • Hyperglycemia
  • Prognosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Hyperglycemia as an independent predictor of worse outcome in non-diabetic patients presenting with acute ischemic stroke. / Stead, Latha G.; Gilmore, Rachel M.; Bellolio, Fernanda; Mishra, Shaily; Bhagra, Anjali; Vaidyanathan, Lekshmi; Decker, Wyatt W.; Brown, Robert D Jr.

In: Neurocritical Care, Vol. 10, No. 2, 04.2009, p. 181-186.

Research output: Contribution to journalArticle

Stead, Latha G. ; Gilmore, Rachel M. ; Bellolio, Fernanda ; Mishra, Shaily ; Bhagra, Anjali ; Vaidyanathan, Lekshmi ; Decker, Wyatt W. ; Brown, Robert D Jr. / Hyperglycemia as an independent predictor of worse outcome in non-diabetic patients presenting with acute ischemic stroke. In: Neurocritical Care. 2009 ; Vol. 10, No. 2. pp. 181-186.
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AB - Objective: To determine if differences in outcome exist between diabetic and non-diabetic patients who present to the Emergency Department (ED) with acute ischemic stoke (AIS) and elevated blood glucose. Methods: The study population consisted of 447 consecutive patients who presented to the ED with AIS within 24 h of symptom onset and had blood glucose measured on presentation. Hyperglycemia was defined as >130 mg/dl. Outcomes studied included infarct volume, stroke severity (NIH Stroke Scale), functional impairment (modified Rankin Score), and 90-day mortality. Patients with hyperglycemia were then stratified into those with and without a prior history of diabetes mellitus (DM) for the purposes of analysis. Results: Patients with hyperglycemia exhibited significantly greater stroke severity (P = 0.002) and greater functional impairment (P = 0.004) than those with normoglycemia. Patients with hyperglycemia were 2.3 times more likely to be dead at 90 days compared to those with normal glucose (P < 0.001). Stroke severity (P < 0.001) and functional impairment (P < 0.001) were both significantly worse in patients with hyperglycemia and no prior history of DM, when compared to patients with hyperglycemia and previously diagnosed DM. Among the patients without a prior history of DM, patients with hyperglycemia were 3.4 times more likely to die within 90 days (P < 0.001) when compared with patients with normoglycemia. In contrast, the hazard ratio was 1.6 among the patients with DM (P = 0.66). Conclusion: Hyperglycemia on presentation is associated with significantly poorer outcomes following AIS. Patients with hyperglycemia and no prior history of DM have a particularly poor prognosis, worse than that for patients with known diabetes and hyperglycemia.

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