| Association of admission blood glucose and outcome in patients treated with intravenous thrombolysis: results from the Safe Implementation of Treatments in Stroke International Stroke Thrombolysis Register (SITS-ISTR). | |
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MedLine Citation:
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PMID: 20837858 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To determine the association between admission blood glucose and outcome in ischemic stroke patients treated with thrombolysis. DESIGN: A prospective, open, multinational, observational study. SETTING: An ongoing Internet-based, academic-driven, interactive thrombolysis register. PATIENTS: Between 2002 and 2007, 16 049 patients were recorded in the SITS-ISTR. MAIN OUTCOME MEASURE: Blood glucose was recorded at admission. Blood glucose was divided into the following categories: less than 80, 80-120 (reference range), 121-140, 141-160, 161-180, 181-200, and greater than 200 mg/dL. Outcomes were mortality and independence (modified Rankin Scale score of 0-2) at 3 months and symptomatic intracerebral hemorrhage (SICH) (National Institutes of Health Stroke Scale deterioration ≥4 points within 24 hours and type 2 parenchymal hemorrhage). RESULTS: In multivariable analysis, blood glucose as a continuous variable was independently associated with a higher mortality (P < .001), lower independence (P < .001), and an increased risk of SICH (P = .005). Blood glucose greater than 120 mg/dL as a categorical variable was associated with a significantly higher odds for mortality (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.07-1.44; P = .004) and a lower odds for independence (OR, 0.58; 95% CI, 0.48-0.70; P < .001), and blood glucose from 181 to 200 mg/dL was associated with an increased risk of SICH (OR, 2.86; 95% CI, 1.69-4.83; P < .001) compared with the reference level. The trends of associations between blood glucose and outcomes were similar in patients with diabetes (17%) or without such history, except for mortality (P = .23) and SICH (P = .06) in which the association was not statistically significant in patients with diabetes. CONCLUSIONS: Admission hyperglycemia was an independent predictor for poor outcome after stroke/thrombolysis, though SICH rates did not increase significantly until reaching 180 mg/dL. These results suggest that tight control of blood glucose may be indicated in the hyperacute phase following thrombolysis. Randomized trial data are needed. |
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Authors:
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Niaz Ahmed; Antoni Dávalos; Niclas Eriksson; Gary A Ford; Joerg Glahn; Michael Hennerici; Robert Mikulik; Markku Kaste; Kennedy R Lees; Perttu J Lindsberg; Danilo Toni; |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Archives of neurology Volume: 67 ISSN: 1538-3687 ISO Abbreviation: Arch. Neurol. Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-09-14 Completed Date: 2010-10-01 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0372436 Medline TA: Arch Neurol Country: United States |
Other Details:
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Languages: eng Pagination: 1123-30 Citation Subset: AIM; IM |
Affiliation:
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Karolinska Stroke Research Unit, Department of Neurology, Karolinska University Hospital-Solna, Stockholm, Sweden. niaz.ahmed@karolinska.se |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Blood Glucose* Brain Ischemia / blood*, diagnosis, drug therapy* Humans Hyperglycemia / blood, diagnosis Injections, Intravenous Multivariate Analysis Predictive Value of Tests Prognosis Prospective Studies Registries Stroke / blood*, diagnosis, drug therapy* Thrombolytic Therapy* Time Factors Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Blood Glucose |
| Investigator | |
Investigator/Affiliation:
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Nils Wahlgren / ; Antoni Davalos / ; Gary A Ford / ; Martin Grond / ; Werner Hacke / ; Michael Hennerici / ; Markku Kaste / ; Vincent Larrue / ; Kennedy R Lees / ; Risto Roine / ; Danilo Toni / |
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