Abstract

Objective: Admission hyperglycemia has been associated with worse outcomes in ischemic stroke. We hypothesized that hyperglycemia (glucose >8.0 mmol/L), in the hyperacute phase would be independently associated with increased mortality, symptomatic intracerebral hemorrhage (SICH) and poor functional status at 90-days in stroke patients treated with intravenous (IV)-tPA.

Research Design and Methods: Using data from the prospective, multicenter Canadian Alteplase for Stroke Effectiveness Study (CASES), the association between admission glucose >8.0 mmol/L and mortality, SICH, and poor functional status at 90-days (modified Rankin Scale [mRS] >1) was examined. Similar analyses were conducted examining glucose as a continuous measure.

Results: Of 1098 patients, 296 (27%) had admission hyperglycemia, including 18% of those without diabetes mellitus and 70% of those with diabetes mellitus. After multivariable logistic regression, admission hyperglycemia was found to be independently associated with increased risk of death (adjusted RR 1.5 (CI₉₅ 1.2 to 1.9), SICH (adjusted RR 1.69 CI₉₅ 0.95 to 3.00) and decreased probability of a favorable outcome at 90 days (adjusted RR 0.7 CI₉₅ 0.5 to 0.9). An incremental risk of death, SICH and unfavorable 90-day outcomes was observed with increasing admission glucose. This held true for patients with and without diabetes mellitus

Conclusions: In this cohort of IV-tPA treated stroke patients, admission hyperglycemia was independently associated with increased risk of death, SICH and poor functional status at 90-days. Treatment trials continue to be urgently needed to determine if this is a modifiable risk factor for poor outcome.