Stress hyperglycemia is predictive of worse outcome in patients with acute ischemic stroke undergoing intravenous thromb
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Stress hyperglycemia is predictive of worse outcome in patients with acute ischemic stroke undergoing intravenous thrombolysis Giovanni Merlino1,2 · Carmelo Smeralda2,3 · Gian Luigi Gigli2,4 · Simone Lorenzut1 · Sara Pez2,3 · Andrea Surcinelli2,3 · Alessandro Marini2,3 · Mariarosaria Valente2,3
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract No study investigated the possible detrimental effect of stress hyperglycemia on patients affected acute ischemic stroke (AIS) undergoing intravenous thrombolysis (IVT). A new index, the glucose-to-glycated hemoglobin ratio (GAR), has been developed for assessing stress hyperglycemia. We retrospectively analyzed data from a prospectively collected database of consecutive patients admitted to the Udine University Hospital with AIS that were treated with IVT from January 2015 to December 2019. Four hundred and fourteen consecutive patients with AIS undergoing IVT entered the study. The patients were then stratified into four groups by quartiles of GAR (Q1–Q4). The higher GAR index was, the more severe stress hyperglycemia was considered. Prevalence of 3 months poor outcome (37.7% for Q1, 34% for Q2, 46.9% for Q3, and 66.7% for Q4, p for trend = 0.001), 3 months mortality (10.5% for Q1, 7.5% for Q2, 11.2% for Q3, and 27.1% for Q4, p for trend = 0.001), and symptomatic intracranial hemorrhage (0.9% for Q1, 0.9% for Q2, 5.1% for Q3, and 17.7% for Q4, p for trend = 0.001) was significant different among the four groups. AIS patients with severe stress hyperglycemia had a significantly increased risk of 3 months poor outcome (OR 2.43, 95% CI 1.14–5.22, p = 0.02), 3 months mortality (OR 2.38, 95% CI 1.01–5.60, p = 0.04), and symptomatic intracranial hemorrhage (OR 16.76, 95% CI 2.09–134.58, p = 0.008) after IVT. In conclusion, we demonstrated that stress hyperglycemia, as measured by the GAR index, is associated to worse outcome in AIS patients undergoing IVT. Keywords Stress hyperglycemia · Acute ischemic stroke · Outcome · Intravenous thrombolysis
Highlights • No study investigated the possible detrimental effect of
stress hyperglycemia on patients affected acute ischemic stroke undergoing intravenous thrombolysis.
Giovanni Merlino and Carmelo Smeralda have contributed equally to this work. * Giovanni Merlino [email protected] 1
Stroke Unit, Department of Neuroscience, Udine University Hospital, Piazzale S. Maria della Misericordia 15, 33100 Udine, Italy
2
Clinical Neurology, Udine University Hospital, Udine, Italy
3
DAME, University of Udine, Udine, Italy
4
DMIF, University of Udine, Udine, Italy
• The glucose-to-glycated hemoglobin ratio was used for
assessing stress hyperglycemia in our patients.
• Patients with severe stress hyperglycemia had a sig-
nificantly increased risk of 3 months poor outcome, 3 months mortality, and symptomatic intracranial hemorrhage.
Introduction Before reperfusion therapy was available, elevated serum glucose has been associated with poor outcome in patients affected by acute
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