Abstract T MP74: The Effect of Elevated Factor VIII on Glycemic Control in Acute Ischemic Stroke Patients

Abstract

Background: Elevated Factor VIII (FVIII) levels are associated with diabetes mellitus (DM) and hyperglycemia and are common in acute ischemic stroke (AIS). We sought to investigate if elevated FVIII would be associated with insulin administration during hospitalization for AIS. Methods: We retrospectively analyzed 219 patients who presented to our center from 07/2008-12/2012 with AIS. Cases were grouped by peristroke FVIII levels (normal: 50-150%; elevated: >150 %;), with a priori subgroup analysis restricted to those with severely elevated FVIII >200%. Per standard orders, glucose is measured at least every 6hrs during the first 48hrs and is treated when >160mg/dl with sliding scale insulin. The odds ratios of receiving various forms of insulin were calculated using logistic regression in four sequentially adjusted models: (1) unadjusted, (2) demographics, (3) added baseline NIHSS and admission glucose and (4) added variables significant in univariate analysis. Results: Patients with elevated FVIII (n=143) were more likely Black, have a history of diabetes and have higher serum glucose and HbA1C’s on admission. Patients with elevated FVIII received more insulin/day than patients with normal FVIII (median 0.71 units vs 0 units, respectively, p=0.0014). In fully adjusted models, insulin use did not differ between normal or elevated FVIII levels. Patients with severely elevated FVIII, however, were 16 times more likely to receive intermediate/long acting insulin to treat hyperglycemia, compared to those with normal FVIII. The presence of severely elevated FVIII elevations did not predict insulin requirements in adjusted models. Conclusion: Our results further support a relationship between FVIII and elevated glucose, particularly in the setting of AIS when hyperglycemia is predictive of poor outcome. Further study is needed to investigate if elevated FVIII levels drive or simply reflect hyperglycemia and may help guide glycemic management in AIS patients.