Abstract
BackgroundThe prognostic influence of hyperglycemia in acute stroke has been well established. While in cortical stroke there is a strong association between hyperglycemia and poor outcome, this relation is less clear in lacunar stroke. It has been suggested that this discrepancy is present among patients treated with intravenous tissue plasminogen activator (tPA), but confirmation is needed.MethodsIn two prospectively collected cohorts of patient treated with intravenous tPA for acute ischemic stroke, we investigated the effect of hyperglycemia (serum glucose level >8 mmol/L) on functional outcome in lacunar and non-lacunar stroke. Poor functional outcome was defined as modified Rankin Scale score ≥ 3 at 3 months.ResultsA total of 1012 patients was included of which 162 patients (16 %) had lacunar stroke. The prevalence of hyperglycemia did not differ between stroke subtypes (22 % vs 21 %, p = 0.85). In multivariate analysis hyperglycemia was associated with poor functional outcome in non-lacunar stroke (OR 2.1, 95 % CI 1.39–3.28, p = 0.001). In patients with lacunar stroke, we did not find an association (OR 1.8, 95 % CI 0.62–4.08, p = 0.43).ConclusionThis study confirms a difference in prognostic influence of hyperglycemia between non-lacunar and lacunar ischemic stroke.
Highlights
The prognostic influence of hyperglycemia in acute stroke has been well established
In patients treated with intravenous recombinant tissue plasminogen antigen, hyperglycemia was associated with lower recanalization rates, poor functional outcome, higher mortality and increased risk of symptomatic intracerebral hemorrhage (SICH) [3,4,5,6,7,8,9,10]
We aimed to investigate the effect of admission hyperglycemia on functional outcome in a large cohort of patients with lacunar and nonlacunar stroke treated with intravenous tissue plasminogen activator (tPA)
Summary
The prognostic influence of hyperglycemia in acute stroke has been well established. While in cortical stroke there is a strong association between hyperglycemia and poor outcome, this relation is less clear in lacunar stroke. In patients treated with intravenous recombinant tissue plasminogen antigen (tPA), hyperglycemia was associated with lower recanalization rates, poor functional outcome, higher mortality and increased risk of symptomatic intracerebral hemorrhage (SICH) [3,4,5,6,7,8,9,10]. Hyperglycemia was associated with poor outcome in patients with large vessel stroke, but a favorable effect of moderate hyperglycemia was suggested in lacunar stroke [7, 9]. Both studies investigated patients that did not receive thrombolytic therapy. In large vessel stroke hyperglycemia was associated with reduced salvage of the penumbra and larger infarct size [6]
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