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Acad Emerg Med. 2006 Feb;13(2):174-80. Epub 2006 Jan 25.

Decreased mortality by normalizing blood glucose after acute ischemic stroke.

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  • 1Temple University School of Medicine, Philadelphia, PA 19140, USA. ngentile@temple.edu

Abstract

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 > or = 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.

PMID:
16436794
[PubMed - indexed for MEDLINE]
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