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
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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