Abstract:
BACKGROUND AND PURPOSE:Evidence is accumulating regarding the prognostic influence of hyperglycemia in patients with acute ischemic stroke. However, the level associated with poor outcome is unknown. Our objectives were to establish the capillary glucose threshold with the highest predictive accuracy of poor outcome and to evaluate its hypothetical value in influencing functional outcome by adjusting for other well-known prognostic factors in acute stroke. METHODS:The authors conducted a multicenter, prospective, and observational cohort study of 476 patients with ischemic stroke within less than 24 hours from stroke onset. Capillary finger-prick glucose and stroke severity were determined on admission and 3 times a day during the first 48 hours. Poor outcome (modified Rankin Scale >2) was evaluated at 3 months. RESULTS:The receiver operating characteristic curves showed the predictive value of maximum capillary glucose at any time within the first 48 hours with an area under the curve of 0.656 (95% CI, 0.592 to 0.720; P<0.01) and pointed to 155 mg/dL as the optimal cutoff level for poor outcome at 3 months (53% sensitivity; 73% specificity). This point was associated with a 2.7-fold increase (95% CI, 1.42 to 5.24) in the odds of poor outcome after adjustment for age, diabetes, capillary glucose on admission, infarct volume, and baseline stroke severity and with a 3-fold increase in the risk of death at 3 months (hazard ratio, 3.80; 95% CI, 1.79 to 8.10). CONCLUSIONS:Hyperglycemia >or=155 mg/dL at any time within the first 48 hours from stroke onset, and not only the isolated value of admission glycemia, is associated with poor outcome independently of stroke severity, infarct volume, diabetes, or age.
journal_name
Strokejournal_title
Strokeauthors
Fuentes B,Castillo J,San José B,Leira R,Serena J,Vivancos J,Dávalos A,Nuñez AG,Egido J,Díez-Tejedor E,Stroke Project of the Cerebrovascular Diseases Study Group, Spanish Society of Neurology.doi
10.1161/STROKEAHA.108.519926subject
Has Abstractpub_date
2009-02-01 00:00:00pages
562-8issue
2eissn
0039-2499issn
1524-4628pii
STROKEAHA.108.519926journal_volume
40pub_type
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