Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Neurology
Published in: BMC Neurology 1/2016

Open Access 01-12-2016 | Research article

Admission hyperglycemia and outcome after intravenous thrombolysis: is there a difference among the stroke-subtypes?

Authors: Irene Miedema, Gert-Jan Luijckx, Raf Brouns, Jacques De Keyser, Maarten Uyttenboogaart

Published in: BMC Neurology | Issue 1/2016

Login to get access

Abstract

Background

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. It has been suggested that this discrepancy is present among patients treated with intravenous tissue plasminogen activator (tPA), but confirmation is needed.

Methods

In 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.

Results

A 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).

Conclusion

This study confirms a difference in prognostic influence of hyperglycemia between non-lacunar and lacunar ischemic stroke.
Literature
1.
Scott JF, Robinson GM, French JM, O'Connell JE, Alberti KG, Gray CS. Prevalence of admission hyperglycemia across clinical subtypes of acute stroke. Lancet. 1999;353(9150):376–7.CrossRefPubMed
2.
Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke. 2001;32(10):2426–32.CrossRefPubMed
3.
Ahmed N, Davalos A, Eriksson N, Ford GA, Glahn J, Hennerici M, et al. Association of admission blood glucose and outcome in patients treated with intravenous thrombolysis: results from the Safe Implementation of Treatments in Stroke International Stroke Thrombolysis Register (SITS-ISTR). Arch Neurol. 2010;67(9):1123–30.CrossRefPubMed
4.
Poppe AY, Majumdar SR, Jeerakathil T, Ghali W, Buchan AM, Hill MD, et al. Admission hyperglycemia predicts a worse outcome in stroke patients treated with intravenous thrombolysis. Diabetes Care. 2009;32(4):617–22.CrossRefPubMed
5.
Weir CJ, Murray GD, Dyker AG, Lees KR. Is hyperglycemia an independent predictor of poor outcome after acute stroke? Results of a long-term follow up study. BMJ. 1997;314(7090):1303–6.CrossRefPubMedPubMedCentral
6.
Parsons MW, Barber PA, Desmond PM, Baird TA, Darby DG, Byrnes G, et al. Acute hyperglycemia adversely affects stroke outcome: a magnetic resonance imaging and spectroscopy study. Ann Neurol. 2002;52(1):20–8.CrossRefPubMed
7.
Uyttenboogaart M, Koch MW, Stewart RE, Vroomen PC, Luijckx GJ, De Keyser J. Moderate hyperglycemia is associated with favourable outcome in acute lacunar stroke. Brain. 2007;130(Pt 6):1626–30.CrossRefPubMed
8.
Alvarez-Sabin J, Molina CA, Ribo M, Arenillas JF, Montaner J, Huertas R, et al. Impact of admission hyperglycemia on stroke outcome after thrombolysis: risk stratification in relation to time to reperfusion. Stroke. 2004;35(11):2493–8.CrossRefPubMed
9.
Bruno A, Biller J, Adams Jr HP, Clarke WR, Woolson RF, Williams LS, et al. Acute blood glucose level and outcome from ischemic stroke. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. Neurology. 1999;52(2):280–4.CrossRefPubMed
10.
Ribo M, Molina C, Montaner J, Rubiera M, Delgado-Mederos R, Arenillas JF, et al. Acute hyperglycemia state is associated with lower tPA-induced recanalization rates in stroke patients. Stroke. 2005;36(8):1705–9.CrossRefPubMed
11.
Luitse MJ, Biessels GJ, Rutten GE, Kappelle LJ. Diabetes, hyperglycemia, and acute ischemic stroke. Lancet Neurol. 2012;11(3):261–71.CrossRefPubMed
12.
Mandava P, Martini SR, Munoz M, Dalmeida W, Sarma AK, Anderson JA, et al. Hyperglycemia worsens outcome after rt-PA primarily in the large-vessel occlusive stroke subtype. Transl Stroke Res. 2014;5(4):519–25.CrossRefPubMed
13.
Uyttenboogaart M, Vroomen PC, Stewart RE, De Keyser J, Luijckx GJ. Safety of routine IV thrombolysis between 3 and 4.5 h after ischemic stroke. J Neurol Sci. 2007;254(1–2):28–32.CrossRefPubMed
14.
Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet. 1991;337(8756):1521–6.CrossRefPubMed
15.
Suh SW, Shin BS, Ma H, Van Hoecke M, Brennan AM, Yenari MA, et al. Glucose and NADPH oxidase drive neuronal superoxide formation in stroke. Ann Neurol. 2008;64(6):654–63.CrossRefPubMedPubMedCentral
16.
Uyttenboogaart M, Stewart RE, Vroomen PC, De Keyser J, Luijckx GJ. Optimizing cutoff scores for the Barthel index and the modified Rankin scale for defining outcome in acute stroke trials. Stroke. 2005;36(9):1984–7.CrossRefPubMed
17.
Kent DM, Selker HP, Ruthazer R, Bluhmki E, Hacke W. The stroke-thrombolytic predictive instrument: a predictive instrument for intravenous thrombolysis in acute ischemic stroke. Stroke. 2006;37(12):2957–62.CrossRefPubMed
18.
Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E, Brott T, et al. Eff ect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014;384(9958):1929–35.CrossRefPubMedPubMedCentral
19.
Anderson RE, Tan WK, Martin HS, Meyer FB. Effects of glucose and PaO2 modulation on cortical intracellular acidosis, NADH redox state, and infarction in the ischemic penumbra. Stroke. 1999;30(1):160–70.CrossRefPubMed
20.
Dietrich WD, Alonso O, Busto R. Moderate hyperglycemia worsens acute blood–brain barrier injury after forebrain ischemia in rats. Stroke. 1993;24(1):111–6.CrossRefPubMed
21.
Kamada H, Yu F, Nito C, Chan PH. Influence of hyperglycemia on oxidative stress and matrix metalloproteinase-9 activation after focal cerebral ischemia/reperfusion in rats: relation to blood–brain barrier dysfunction. Stroke. 2007;38(3):1044–9.CrossRefPubMedPubMedCentral
22.
Kruyt ND, Biessels GJ, Devries JH, Roos YB. Hyperglycemia in acute ischemic stroke: pathophysiology and clinical management. Nat Rev Neurol. 2010;6(3):145–55.CrossRefPubMed
23.
Martini SR, Kent TA. Hyperglycemia in acute ischemic stroke: a vascular perspective. J Cereb Blood Flow Metab. 2007;27(3):435–51.CrossRefPubMed
24.
Vaidyula VR, Rao AK, Mozzoli M, Homko C, Cheung P, Boden G. Effects of hyperglycemia and hyperinsulinemia on circulating tissue factor procoagulant activity and platelet CD40 ligand. Diabetes. 2006;55(1):202–8.CrossRefPubMed
25.
Won SJ, Tang XN, Suh SW, Yenari MA, Swanson RA. Hyperglycemia promotes tissue plasminogen activator-induced hemorrhage by Increasing superoxide production. Ann Neurol. 2011;70(4):583–90.
26.
27.
Sanchez-Abarca LI, Tabernero A, Medina JM. Oligodendrocytes use lactate as a source of energy and as a precursor of lipids. Glia. 2001;36(3):321–9.CrossRefPubMed
28.
Brouns R, Sheorajpanday R, Wauters A, De Surgeloose D, Marien P, De Deyn PP. Evaluation of lactate as a marker of metabolic stress and cause of secondary damage in acute ischemic stroke or TIA. Clin Chim Acta. 2008;397(1–2):27–31.CrossRefPubMed
29.
Bellolio MF, Gilmore RM, Stead LG. Insulin for glycaemic control in acute ischemic stroke. Cochrane Database Syst Rev. 2011;9(9):CD005346.PubMed
30.
Gray CS, Hildreth AJ, Sandercock PA, O'Connell JE, Johnston DE, Cartlidge NE, et al. Glucose-potassium-insulin infusions in the management of post-stroke hyperglycemia: the UK Glucose Insulin in Stroke Trial (GIST-UK). Lancet Neurol. 2007;6(5):397–406.CrossRefPubMed
Metadata
Title
Admission hyperglycemia and outcome after intravenous thrombolysis: is there a difference among the stroke-subtypes?
Authors
Irene Miedema
Gert-Jan Luijckx
Raf Brouns
Jacques De Keyser
Maarten Uyttenboogaart
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2016
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-016-0617-0

Other articles of this Issue 1/2016

BMC Neurology 1/2016 Go to the issue

Research article

Effects of clobazam for treatment of refractory status epilepticus

Study protocol

ICC-dementia (International Centenarian Consortium - dementia): an international consortium to determine the prevalence and incidence of dementia in centenarians across diverse ethnoracial and sociocultural groups

Research article

Low total cholesterol level is the independent predictor of poor outcomes in patients with acute ischemic stroke: a hospital-based prospective study

Research article

Reversible splenial lesion syndrome associated with encephalitis/encephalopathy presenting with great clinical heterogeneity

Erratum

Erratum to: PRISM II: an open-label study to assess effectiveness of dextromethorphan/quinidine for pseudobulbar affect in patients with dementia, stroke or traumatic brain injury

Research article

The effects of a mindfulness-based lifestyle program for adults with Parkinson’s disease: a mixed methods, wait list controlled randomised control study