Decreased Mortality by Normalizing Blood Glucose after Acute Ischemic Stroke

• Published in: Academic emergency medicine Vol. 13; no. 2; pp. 174 - 180
• Main Authors: Gentile, Nina T., Seftchick, Michael W., Huynh, Tien, Kruus, Linda K., Gaughan, John
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.02.2006
• Subjects: cerebral ischemia; cerebrovascular injury; glucose; stroke
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1197/j.aem.2005.08.009

Objectives: Hyperglycemia after cerebral ischemia exacerbates brain injury and worsens the outcome of stroke patients. The authors sought to examine the effect of glycemic control on mortality after acute stroke. Methods: This was a retrospective study of patients discharged with a diagnosis of ischemic stroke during a 40‐month period from a large urban U.S. health system. Patients were compared by initial blood glucose (BG) levels and by glycemic control during the first 48 hours of hospitalization. Results: Of 960 patients with thromboembolic stroke, 373 (38.9%) were hyperglycemic (BG ≥130 mg/dL) on hospital admission. Admission hyperglycemia was associated with a higher mortality rate than was euglycemia (odds ratio [OR] = 3.15; 95% confidence interval [CI] = 1.45 to 6.85; p = 0.004). Persistent hyperglycemia (PerHyp) during 48 hours of hospitalization was associated with even higher mortality rate (unadjusted logistic regression, OR = 6.54; 95% CI = 2.41 to 17.87; p < 0.001). Glycemic control (normalization of BG to < 130 mg/dL) was associated with a 4.6‐fold decrease in mortality risk as compared with the case of patients with PerHyp (p < 0.001). Multiple logistic regression showed glycemic control to be a strong independent determinant of survival (OR = 5.95; 95% CI = 1.24 to 28.6; p = 0.026) after acute stroke even after adjustment for age, gender, concomitant hypertension and diabetes, and stroke severity. Conclusions: Admission hyperglycemia is associated with a worse outcome after stroke than is euglycemia. Normalization of blood glucose during the first 48 hours of hospitalization appears to confer a potent survival benefit in patients with thromboembolic stroke.