Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2015 Sep 25;4(10):e002193.
doi: 10.1161/JAHA.115.002193.

Association of Acute and Chronic Hyperglycemia With Acute Ischemic Stroke Outcomes Post-Thrombolysis: Findings From Get With The Guidelines-Stroke

Shihab Masrur  1 , Margueritte Cox  2 , Deepak L Bhatt  3 , Eric E Smith  4 , Gray Ellrodt  5 , Gregg C Fonarow  6 , Lee Schwamm  7
Affiliations
Observational Study

Association of Acute and Chronic Hyperglycemia With Acute Ischemic Stroke Outcomes Post-Thrombolysis: Findings From Get With The Guidelines-Stroke

Shihab Masrur et al. J Am Heart Assoc. .

Abstract

Background: Hyperglycemia has been associated with adverse outcomes in patients with acute ischemic stroke (AIS) and may influence outcomes after tissue plasminogen activator (tPA). We sought to analyze the association of acute and chronic hyperglycemia on clinical outcomes in tPA-treated patients.

Methods and results: We identified 58 265 AIS patients from 1408 sites who received tPA from 2009 to 2013 in Get With The Guidelines-Stroke. Acute hyperglycemia at admission was defined as a plasma glucose level >140 mg/dL. Chronic hyperglycemia was defined by plasma glycosylated hemoglobin (HbA1c) >6.5%. Post-tPA outcomes were analyzed using logistic regression. Blood glucose >140 mg/dL and HbA1c >6.5 were associated with worse clinical outcomes (symptomatic intracranial hemorrhage [sICH], life-threatening hemorrhage, and in-hospital mortality and length of stay) in diabetic and nondiabetic patients. Among patients with documented history of diabetes, increasing admission glucose up to 200 mg/dL was associated with increased adjusted odds ratio (aOR) of in-hospital mortality (aOR, 1.07) and sICH (aOR, 1.05) per 10 mg/dL increase in blood glucose. Increasing HbA1C to 8% was associated with increased odds of in-hospital mortality (aOR, 1.19) and sICH (aOR, 1.16) per 1% increase in HbA1c. Similar findings were observed in patients without a documented history of diabetes. There was no further increase in poor outcomes above the blood glucose level of 200 mg/dL or HbA1c >8.

Conclusion: Acute and chronic hyperglycemia are both associated with increased mortality and worse clinical outcomes in AIS patients treated with tPA. Controlled trials are needed to determine whether acute correction of hyperglycemia can improve outcomes after thrombolysis.

Keywords: acute stroke; hyperglycemia; tissue plasminogen activator.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Distribution of admission blood glucose (BG) values.
Figure 2
Figure 2
Distribution of glycosylated hemoglobin (HbA1c) values.
Figure 3
Figure 3
A, Predicted probability of in‐hospital mortality (adjusted) with 95% confidence intervals; B, predicted probability of symptomatic intracranial hemorrhage (adjusted) with 95% confidence intervals.
Figure 4
Figure 4
A, Predicted probability of in‐hospital mortality (adjusted) with 95% confidence intervals; B, predicted probability of symptomatic intracranial hemorrhage (adjusted) with 95% confidence intervals. HbA1c indicates glycosylated hemoglobin.
See this image and copyright information in PMC

References

    1. Sprafka JM, Virnig BA, Shahar E, McGovern PG. Trends in diabetes prevalence among stroke patients and the effect of diabetes on stroke survival: the Minnesota Heart Survey. Diabet Med. 1994;11:678–684. - PubMed
    1. Megherbi SE, Milan C, Minier D, Couvreur G, Osseby GV, Tilling K, Di Carlo A, Inzitari D, Wolfe CD, Moreau T, Giroud M; European BSoSCG . Association between diabetes and stroke subtype on survival and functional outcome 3 months after stroke: data from the European BIOMED Stroke Project. Stroke. 2003;34:688–694. - PubMed
    1. Bruno A, Biller J, Adams HP Jr, Clarke WR, Woolson RF, Williams LS, Hansen MD. Acute blood glucose level and outcome from ischemic stroke. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. Neurology. 1999;52:280–284. - PubMed
    1. Weir CJ, Murray GD, Dyker AG, Lees KR. Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long‐term follow up study. BMJ. 1997;314:1303–1306. - PMC - PubMed
    1. Bruno A, Levine SR, Frankel MR, Brott TG, Lin Y, Tilley BC, Lyden PD, Broderick JP, Kwiatkowski TG, Fineberg SE; Group Nr‐PSS . Admission glucose level and clinical outcomes in the NINDS rt‐PA Stroke Trial. Neurology. 2002;59:669–674. - PubMed

Publication types

MeSH terms