High Admission Glucose Is Associated With Poor Outcome After Endovascular Treatment for Ischemic Stroke
Autor: | Rinkel, Leon A., Nguyen, T. Truc My, Guglielmi, Valeria, Groot, Adrien E., Posthuma, Laura, Roos, Yvo B. W. E. M., Majoie, Charles B. L. M., Lycklama a Nijeholt, Geert J., Emmer, Bart J., van der Worp, H. Bart, Wermer, Marieke J. H., Kruyt, Nyika D., Coutinho, Jonathan M., van Zwam, Wim, van Oostenbrugge, Robert Jan |
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Přispěvatelé: | Graduate School, Neurology, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, ACS - Pulmonary hypertension & thrombosis, ANS - Neurovascular Disorders, Radiology and Nuclear Medicine, RS: Carim - B06 Imaging, RS: Carim - B05 Cerebral small vessel disease, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), MUMC+: Hersen en Zenuw Centrum (3), MUMC+: MA Neurologie (3), RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, Klinische Neurowetenschappen |
Jazyk: | angličtina |
Rok vydání: | 2020 |
Předmět: |
Blood Glucose
Male medicine.medical_treatment Outcome (game theory) Severity of Illness Index ANGIOGRAPHY Postoperative Complications Medicine odds ratio glucose Stroke Netherlands Thrombectomy Aged 80 and over medicine.diagnostic_test Cerebral infarction adult Endovascular Procedures BLOOD-GLUCOSE Middle Aged cerebral infarction INSULIN STATE reperfusion Hospitalization Treatment Outcome Disease Progression Female TRIAL Cardiology and Cardiovascular Medicine Intracranial Hemorrhages POSTSTROKE HYPERGLYCEMIA medicine.medical_specialty Internal medicine Humans Endovascular treatment METAANALYSIS Aged Ischemic Stroke Advanced and Specialized Nursing business.industry Insulin Odds ratio Pneumonia medicine.disease Functional Status Hyperglycemia Ischemic stroke Angiography Neurology (clinical) business |
Zdroj: | Stroke; a journal of cerebral circulation, 51(11), 3215-3223. Lippincott Williams and Wilkins Stroke, 51(11), 3215-3223. LIPPINCOTT WILLIAMS & WILKINS |
ISSN: | 1524-4628 0039-2499 |
Popis: | Background and Purpose: High-serum glucose on admission is a predictor of poor outcome after stroke. We assessed the association between glucose concentrations and clinical outcomes in patients who underwent endovascular treatment. Methods: From the MR CLEAN Registry, we selected consecutive adult patients with a large vessel occlusion of the anterior circulation who underwent endovascular treatment and for whom admission glucose levels were available. We assessed the association between admission glucose and the modified Rankin Scale score at 90 days, symptomatic intracranial hemorrhage and successful reperfusion rates. Hyperglycemia was defined as admission glucose ≥7.8 mmol/L. We evaluated the association between glucose and modified Rankin Scale using multivariable ordinal logistic regression and assessed whether successful reperfusion (extended Thrombolysis in Cerebral Infarction 2b-3) modified this association. Results: Of 3637 patients in the MR CLEAN Registry, 2908 were included. Median admission glucose concentration was 6.8 mmol/L (interquartile range, 5.9–8.1) and 882 patients (30%) had hyperglycemia. Hyperglycemia on admission was associated with a shift toward worse functional outcome (median modified Rankin Scale score 4 versus 3; adjusted common odds ratio, 1.69 [95% CI, 1.44–1.99]), increased mortality (40% versus 23%; adjusted odds ratio, 1.95 [95% CI, 1.60–2.38]), and an increased risk of symptomatic intracranial hemorrhage (9% versus 5%; adjusted odds ratio, 1.94 [95% CI, 1.41–2.66]) compared with nonhyperglycemic patients. The association between admission glucose levels and poor outcome (modified Rankin Scale score 3–6) was J -shaped. Hyperglycemia was not associated with the rate of successful reperfusion nor did successful reperfusion modify the association between glucose and functional outcome. Conclusions: Increased admission glucose is associated with poor functional outcome and an increased risk of symptomatic intracranial hemorrhage after endovascular treatment. |
Databáze: | OpenAIRE |
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