Papers

Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long term follow up study

^a Acute Stroke Unit, University Department of Medicine and Therapeutics, Western Infirmary, Glasgow G11 6NT, ^b Robertson Centre for Biostatistics, University of Glasgow, Glasgow G12 8QQ

Correspondence to: Mr Weir

Objective: To determine whether raised plasma glucose concentration independently influences outcome after acute stroke or is a stress response reflecting increased stroke severity.
Design: Long term follow up study of patients admitted to an acute stroke unit.
Setting: Western Infirmary, Glasgow.
Subjects: 811 patients with acute stroke confirmed by computed tomography. Analysis was restricted to the 750 non-diabetic patients.
Main outcome measures: Survival time and placement three months after stroke.
Results: 645 patients (86%) had ischaemic stroke and 105 patients (14%) haemorrhagic stroke. Cox's proportional hazards modelling with stratification according to Oxfordshire Community Stroke Project categories identified increased age (relative hazard 1.36 per decade; 95% confidence interval 1.21 to 1.53), haemorrhagic stroke (relative hazard 1.67; 1.22 to 2.28), time to resolution of symptoms >72 hours (relative hazard 2.15; 1.15 to 4.05), and hyperglycaemia (relative hazard 1.87; 1.43 to 2.45) as predictors of mortality. The effect of glucose concentration on survival was greatest in the first month.
Conclusions: Plasma glucose concentration above 8 mmol/l after acute stroke predicts a poor prognosis after correcting for age, stroke severity, and stroke subtype. Raised plasma glucose concentration is therefore unlikely to be solely a stress response and should arguably be treated actively. A randomised trial is warranted.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Article

Secondary prevention for stroke and transient ischaemic attacks: Horizons needs expanding

Sumantra Ray, Alexander S F Doney, and Ronald S MacWalter
BMJ 2004 328: 896. [Extract] [Full Text]

This article has been cited by other articles:

• Kostulas, N., Markaki, I., Cansu, H., Masterman, T., Kostulas, V. (2009). Hyperglycaemia in acute ischaemic stroke is associated with an increased 5-year mortality. Age Ageing 38: 590-594 [Abstract] [Full text]  
• O'Connell, J. E., Hildreth, A. J., Gray, C. S. (2009). The Glycemia in Acute Stroke Study. Stroke 40: e511-e511 [Full text]  
• Kidwell, C. S., Lees, K. R., Muir, K. W., Chen, C., Davis, S. M., De Silva, D. A., Weir, C. J., Starkman, S., Alger, J. R., Saver, J. L., for the MR IMAGES Investigators, (2009). Results of the MRI Substudy of the Intravenous Magnesium Efficacy in Stroke Trial. Stroke 40: 1704-1709 [Abstract] [Full text]  
• Poppe, A. Y., Majumdar, S. R., Jeerakathil, T., Ghali, W., Buchan, A. M., Hill, M. D., the Canadian Alteplase for Stroke Effectiveness St, (2009). Admission Hyperglycemia Predicts a Worse Outcome in Stroke Patients Treated With Intravenous Thrombolysis. Diabetes Care 32: 617-622 [Abstract] [Full text]  
• Fuentes, B., Castillo, J., San Jose, B., Leira, R., Serena, J., Vivancos, J., Davalos, A., Nunez, A. G., Egido, J., Diez-Tejedor, E., for the Stroke Project of the Cerebrovascular Dise, (2009). The Prognostic Value of Capillary Glucose Levels in Acute Stroke: The GLycemia in Acute Stroke (GLIAS) Study. Stroke 40: 562-568 [Abstract] [Full text]  
• Yong, M., Kaste, M. (2008). Dynamic of Hyperglycemia as a Predictor of Stroke Outcome in the ECASS-II Trial. Stroke 39: 2749-2755 [Abstract] [Full text]  
• McCormick, M. T., Muir, K. W., Gray, C. S., Walters, M. R. (2008). Management of Hyperglycemia in Acute Stroke: How, When, and for Whom?. Stroke 39: 2177-2185 [Full text]  
• Pasternak, J. J., McGregor, D. G., Schroeder, D. R., Lanier, W. L., Shi, Q., Hindman, B. J., Clarke, W. R., Torner, J. C., Weeks, J. B., Todd, M. M., IHAST Investigators, (2008). Hyperglycemia in Patients Undergoing Cerebral Aneurysm Surgery: Its Association With Long-term Gross Neurologic and Neuropsychological Function. Mayo Clin Proc. 83: 406-417 [Abstract] [Full text]  
• Penfold, S., Gouni, R., Hamilton, P., Richardson, T., Kerr, D. (2008). Immediate in-patient management of hyperglycaemia--confusion rather than consensus?. QJM 101: 87-90 [Abstract] [Full text]  
• Ay, H., Arsava, E. M., Koroshetz, W. J., Sorensen, A. G. (2008). Middle Cerebral Artery Infarcts Encompassing the Insula Are More Prone to Growth. Stroke 39: 373-378 [Abstract] [Full text]  
• Air, E. L., Kissela, B. M. (2007). Diabetes, the Metabolic Syndrome, and Ischemic Stroke: Epidemiology and possible mechanisms. Diabetes Care 30: 3131-3140 [Full text]  
• Asadollahi, K., Beeching, N., Gill, G. (2007). Hyperglycaemia and mortality. JRSM 100: 503-507 [Abstract] [Full text]  
• Broderick, J., Connolly, S., Feldmann, E., Hanley, D., Kase, C., Krieger, D., Mayberg, M., Morgenstern, L., Ogilvy, C. S., Vespa, P., Zuccarello, M. (2007). REPRINT: Guidelines for the Management of Spontaneous Intracerebral Hemorrhage in Adults: 2007 Update: A Guideline From the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.. Circulation 116: e391-e413 [Abstract] [Full text]  
• Uyttenboogaart, M., Koch, M. W., Stewart, R. E., Vroomen, P. C., Luijckx, G.-J., De Keyser, J. (2007). Moderate hyperglycaemia is associated with favourable outcome in acute lacunar stroke. Brain 130: 1626-1630 [Abstract] [Full text]  
• Broderick, J., Connolly, S., Feldmann, E., Hanley, D., Kase, C., Krieger, D., Mayberg, M., Morgenstern, L., Ogilvy, C. S., Vespa, P., Zuccarello, M. (2007). Guidelines for the Management of Spontaneous Intracerebral Hemorrhage in Adults: 2007 Update: A Guideline From the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.. Stroke 38: 2001-2023 [Abstract] [Full text]  
• Adams, H. P. Jr, del Zoppo, G., Alberts, M. J., Bhatt, D. L., Brass, L., Furlan, A., Grubb, R. L., Higashida, R. T., Jauch, E. C., Kidwell, C., Lyden, P. D., Morgenstern, L. B., Qureshi, A. I., Rosenwasser, R. H., Scott, P. A., Wijdicks, E. F.M. (2007). Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.. Circulation 115: e478-e534 [Abstract] [Full text]  
• Adams, H. P. Jr, del Zoppo, G., Alberts, M. J., Bhatt, D. L., Brass, L., Furlan, A., Grubb, R. L., Higashida, R. T., Jauch, E. C., Kidwell, C., Lyden, P. D., Morgenstern, L. B., Qureshi, A. I., Rosenwasser, R. H., Scott, P. A., Wijdicks, E. F.M. (2007). Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke 38: 1655-1711 [Abstract] [Full text]  
• Dawson, J., Walters, M. (2006). New and emerging treatments for stroke. Br Med Bull 0: ldl011v1-16 [Abstract] [Full text]  
• Martini, S. R., Hill, M. D., Alexandrov, A. V., Molina, C. A., Kent, T. A. (2006). Outcome in hyperglycemic stroke with ultrasound-augmented thrombolytic therapy.. Neurology 67: 700-702 [Abstract] [Full text]  
• Christoforidis, G.A., Mohammad, Y., Avutu, B., Tejada, A., Slivka, A.P. (2006). Arteriographic Demonstration of Slow Antegrade Opacification Distal to a Cerebrovascular Thromboembolic Occlusion Site As a Favorable Indicator for Intra-Arterial Thrombolysis. Am. J. Neuroradiol. 27: 1528-1531 [Abstract] [Full text]  
• Wintergerst, K. A., Buckingham, B., Gandrud, L., Wong, B. J., Kache, S., Wilson, D. M. (2006). Association of Hypoglycemia, Hyperglycemia, and Glucose Variability With Morbidity and Death in the Pediatric Intensive Care Unit. Pediatrics 118: 173-179 [Abstract] [Full text]  
• Vancheri, F., Curcio, M., Burgio, A., Salvaggio, S., Gruttadauria, G., Lunetta, M.C., Dovico, R., Alletto, M. (2005). Impaired glucose metabolism in patients with acute stroke and no previous diagnosis of diabetes mellitus. QJM 98: 871-878 [Abstract] [Full text]  
• Martin, C. L. (2005). Case Study: Whose Diabetes Is It Anyway? Diabetes Self-Management After a Stroke. Diabetes Spectr. 18: 196-198 [Full text]  
• Bland, D. K., Fankhanel, Y., Langford, E., Lee, M., Lee, S. W., Maloney, C., Rogers, M., Zimmerman, G. (2005). Intensive Versus Modified Conventional Control of Blood Glucose Level in Medical Intensive Care Patients: A Pilot Study. Am J Crit Care 14: 370-376 [Abstract] [Full text]  
• Fogelholm, R, Murros, K, Rissanen, A, Avikainen, S (2005). Admission blood glucose and short term survival in primary intracerebral haemorrhage: a population based study. J. Neurol. Neurosurg. Psychiatry 76: 349-353 [Abstract] [Full text]  
• Conner, T. M, Flesner-Gurley, K. R, Barner, J. C (2005). Hyperglycemia in the Hospital Setting: The Case for Improved Control Among Non-Diabetics. The Annals of Pharmacotherapy 39: 492-501 [Abstract] [Full text]  
• Kernan, W. N., Viscoli, C. M., Inzucchi, S. E., Brass, L. M., Bravata, D. M., Shulman, G. I., McVeety, J. C. (2005). Prevalence of Abnormal Glucose Tolerance Following a Transient Ischemic Attack or Ischemic Stroke. Arch Intern Med 165: 227-233 [Abstract] [Full text]  
• Fulgham, J. R., Ingall, T. J., Stead, L. G., Cloft, H. J., Wijdicks, E. F. M., Flemming, K. D. (2004). Management of Acute Ischemic Stroke. Mayo Clin Proc. 79: 1459-1469 [Abstract]  
• Alvarez-Sabin, J., Molina, C. A., Ribo, M., Arenillas, J. F., Montaner, J., Huertas, R., Santamarina, E., Rubiera, M. (2004). Impact of Admission Hyperglycemia on Stroke Outcome After Thrombolysis: Risk Stratification in Relation to Time to Reperfusion. Stroke 35: 2493-2498 [Abstract] [Full text]  
• Pittas, A. G., Siegel, R. D., Lau, J. (2004). Insulin Therapy for Critically Ill Hospitalized Patients: A Meta-analysis of Randomized Controlled Trials. Arch Intern Med 164: 2005-2011 [Abstract] [Full text]  
• Bloomgarden, Z. T. (2004). Inpatient Diabetes Control: Rationale. Diabetes Care 27: 2074-2080 [Full text]  
• Leigh, R., Zaidat, O. O., Suri, M. F., Lynch, G., Sundararajan, S., Sunshine, J. L., Tarr, R., Selman, W., Landis, D. M.D., Suarez, J. I. (2004). Predictors of Hyperacute Clinical Worsening in Ischemic Stroke Patients Receiving Thrombolytic Therapy. Stroke 35: 1903-1907 [Abstract] [Full text]  
• Lewis, K. S, Kane-Gill, S. L, Bobek, M. B., Dasta, J. F (2004). Intensive Insulin Therapy for Critically Ill Patients. The Annals of Pharmacotherapy 38: 1243-1251 [Abstract] [Full text]  
• Ray, S., Doney, A. S F, MacWalter, R. S (2004). Secondary prevention for stroke and transient ischaemic attacks: Horizons needs expanding. BMJ 328: 896-896 [Full text]  
• Counsell, C, Dennis, M, McDowall, M (2004). Predicting functional outcome in acute stroke: comparison of a simple six variable model with other predictive systems and informal clinical prediction. J. Neurol. Neurosurg. Psychiatry 75: 401-405 [Abstract] [Full text]  
• Andersen, S. K., Gjedsted, J., Christiansen, C., Tonnesen, E. (2004). The roles of insulin and hyperglycemia in sepsis pathogenesis. J. Leukoc. Biol. 75: 413-421 [Abstract] [Full text]  
• Turcot, D. B., Kiernan, F. J., McKay, R. G., Grey, N. J., Boden, W., Perdrizet, G. A. (2004). Acute Hyperglycemia: Implications for contrast-induced nephropathy during cardiac catheterization. Diabetes Care 27: 620-621 [Full text]  
• Gray, C. S., Hildreth, A. J., Alberti, G. K.M.M., O'Connell, J. E. (2004). Poststroke Hyperglycemia: Natural History and Immediate Management. Stroke 35: 122-126 [Abstract] [Full text]  
• Krinsley, J. S. (2003). Association Between Hyperglycemia and Increased Hospital Mortality in a Heterogeneous Population of Critically Ill Patients. Mayo Clin Proc. 78: 1471-1478 [Abstract]  
• Passero, S., Ciacci, G., Ulivelli, M. (2003). The influence of diabetes and hyperglycemia on clinical course after intracerebral hemorrhage. Neurology 61: 1351-1356 [Abstract] [Full text]  
• Baird, T. A., Parsons, M. W., Phanh, T., Butcher, K. S., Desmond, P. M., Tress, B. M., Colman, P. G., Chambers, B. R., Davis, S. M. (2003). Persistent Poststroke Hyperglycemia Is Independently Associated With Infarct Expansion and Worse Clinical Outcome. Stroke 34: 2208-2214 [Abstract] [Full text]  
• Bravata, D.M., Kim, N., Concato, J., Brass, L.M. (2003). Hyperglycaemia in patients with acute ischaemic stroke: how often do we screen for undiagnosed diabetes?. QJM 96: 491-497 [Abstract] [Full text]  
• Adams, H. P. Jr, Adams, R. J., Brott, T., del Zoppo, G. J., Furlan, A., Goldstein, L. B., Grubb, R. L., Higashida, R., Kidwell, C., Kwiatkowski, T. G., Marler, J. R., Hademenos, G. J. (2003). Guidelines for the Early Management of Patients With Ischemic Stroke: A Scientific Statement From the Stroke Council of the American Stroke Association. Stroke 34: 1056-1083 [Full text]  
• Hilker, R., Poetter, C., Findeisen, N., Sobesky, J., Jacobs, A., Neveling, M., Heiss, W.-D. (2003). Nosocomial Pneumonia After Acute Stroke: Implications for Neurological Intensive Care Medicine. Stroke 34: 975-981 [Abstract] [Full text]  
• Umpierrez, G. E., Kitabchi, A. E. (2003). Authors' Response: Hyperglycemia--An Independent Marker of In-Hospital Mortality in Patients with Undiagnosed Diabetes. J. Clin. Endocrinol. Metab. 88: 1402-1402 [Full text]  
• Bruno, A., Levine, S. R., Frankel, M. R., Brott, T. G., Lin, Y., Tilley, B. C., Lyden, P. D., Broderick, J. P., Kwiatkowski, T. G., Fineberg, S. E. (2002). Admission glucose level and clinical outcomes in the NINDS rt-PA Stroke Trial. Neurology 59: 669-674 [Abstract] [Full text]  
• Fukui, S., Otani, N., Katoh, H., Tsuzuki, N., Ishihara, S., Ohnuki, A., Miyazawa, T., Nawashiro, H., Shima, K. (2002). Female gender as a risk factor for hypokalemia and QT prolongation after subarachnoid hemorrhage. Neurology 59: 134-136 [Abstract] [Full text]  
• Umpierrez, G. E., Isaacs, S. D., Bazargan, N., You, X., Thaler, L. M., Kitabchi, A. E. (2002). Hyperglycemia: An Independent Marker of In-Hospital Mortality in Patients with Undiagnosed Diabetes. J. Clin. Endocrinol. Metab. 87: 978-982 [Abstract] [Full text]  
• Kase, C. S., Furlan, A. J., Wechsler, L. R., Higashida, R. T., Rowley, H. A., Hart, R. G., Molinari, G. F., Frederick, L. S., Roberts, H. C., Gebel, J. M., Sila, C. A., Schulz, G. A., Roberts, R. S., Gent, M. (2001). Cerebral hemorrhage after intra-arterial thrombolysis for ischemic stroke: The PROACT II trial. Neurology 57: 1603-1610 [Abstract] [Full text]  
• Boysen, G., Christensen, H. (2001). Early Stroke: A Dynamic Process. Stroke 32: 2423-2425 [Full text]  
• Capes, S. E., Hunt, D., Malmberg, K., Pathak, P., Gerstein, H. C. (2001). Stress Hyperglycemia and Prognosis of Stroke in Nondiabetic and Diabetic Patients: A Systematic Overview. Stroke 32: 2426-2432 [Abstract] [Full text]  
• Demchuk, A. M., Tanne, D., Hill, M. D., Kasner, S. E., Hanson, S., Grond, M., Levine, S. R. (2001). Predictors of good outcome after intravenous tPA for acute ischemic stroke. Neurology 57: 474-480 [Abstract] [Full text]  
• Kagansky, N., Levy, S., Knobler, H. (2001). The Role of Hyperglycemia in Acute Stroke. Arch Neurol 58: 1209-1212 [Abstract] [Full text]  
• Scott, J F, Robinson, G M, French, J M, O'Connell, J E, Alberti, K G M M, Gray, C S (2001). Blood pressure response to glucose potassium insulin therapy in patients with acute stroke with mild to moderate hyperglycaemia. J. Neurol. Neurosurg. Psychiatry 70: 401-404 [Abstract] [Full text]  
• Bhalla, A., Wolfe, C.D.A., Rudd, A.G. (2001). Management of acute physiological parameters after stroke. QJM 94: 167-172 [Abstract] [Full text]  
• Sinha, S., Warburton, E.A. (2000). The evolution of stroke units--towards a more intensive approach?. QJM 93: 633-638 [Full text]  
• James, P, Ellis, C J, Whitlock, R M L, McNeil, A R, Henley, J, Anderson, N E (2000). Relation between troponin T concentration and mortality in patients presenting with an acute stroke: observational study. BMJ 320: 1502-1504 [Abstract] [Full text]  
• Hill, S. E., van Wermeskerken, G. K., Lardenoye, J.-W. H., Phillips-Bute, B., Smith, P. K., Reves, J. G., Newman, M. F. (2000). Intraoperative physiologic variables and outcome in cardiac surgery: part I. In-hospital mortality. Ann. Thorac. Surg. 69: 1070-1075 [Abstract] [Full text]  
• van Wermeskerken, G. K., Lardenoye, J.-W. H., Hill, S. E., Grocott, H. P., Phillips-Bute, B., Smith, P. K., Reves, J. G., Newman, M. F. (2000). Intraoperative physiologic variables and outcome in cardiac surgery: part II. Neurologic outcome. Ann. Thorac. Surg. 69: 1077-1083 [Abstract] [Full text]  
• (2000). Phase II Studies of the Glycine Antagonist GV150526 in Acute Stroke : The North American Experience. Stroke 31: 358-365 [Abstract] [Full text]  
• Becker, K. J., Baxter, A. B., Bybee, H. M., Tirschwell, D. L., Abouelsaad, T., Cohen, W. A. (1999). Extravasation of Radiographic Contrast Is an Independent Predictor of Death in Primary Intracerebral Hemorrhage. Stroke 30: 2025-2032 [Abstract] [Full text]  
• Davis, M., Barer, D. (1999). Neuroprotection in acute ischaemic stroke. II: Clinical potential. Vasc Med 4: 149-163 [Abstract]  
• Wein, T. H., Smith, M. A., Morgenstern, L. B. (1999). Race/Ethnicity and Location of Stroke Mortality : Implications for Population-Based Studies. Stroke 30: 1501-1505 [Abstract] [Full text]  
• Dyker, A. G., Lees, K. R. (1999). Safety and Tolerability of GV150526 (a Glycine Site Antagonist at the N-Methyl-D-Aspartate Receptor) in Patients With Acute Stroke. Stroke 30: 986-992 [Abstract] [Full text]  
• Scott, J. F., Robinson, G. M., French, J. M., O'Connell, J. E., Alberti, K.G.M.M., Gray, C. S. (1999). Glucose Potassium Insulin Infusions in the Treatment of Acute Stroke Patients With Mild to Moderate Hyperglycemia : The Glucose Insulin in Stroke Trial (GIST). Stroke 30: 793-799 [Abstract] [Full text]  
• Demchuk, A. M., Morgenstern, L. B., Krieger, D. W., Linda Chi, T., Hu, W., Wein, T. H., Hardy, R. J., Grotta, J. C., Buchan, A. M. (1999). Serum Glucose Level and Diabetes Predict Tissue Plasminogen Activator–Related Intracerebral Hemorrhage in Acute Ischemic Stroke. Stroke 30: 34-39 [Abstract] [Full text]  
• Bruno, A., Biller, J., Adams, H. P. Jr., Clarke, W. R., Woolson, R. F., Williams, L. S., Hansen, M. D. (1999). Acute blood glucose level and outcome from ischemic stroke. Neurology 52: 280-280 [Abstract] [Full text]  
• Bath, F. J., Owen, V. E., Bath, P. M. W. (1998). Quality of Full and Final Publications Reporting Acute Stroke Trials : A Systematic Review. Stroke 29: 2203-2210 [Abstract] [Full text]  
• McCarron, M. O., Muir, K. W., Weir, C. J., Dyker, A. G., Bone, I., Nicoll, J.A.R., Lees, K.R. (1998). The Apolipoprotein E {epsilon}4 Allele and Outcome in Cerebrovascular Disease. Stroke 29: 1882-1887 [Abstract] [Full text]  
• (1998). Management soon after a stroke. DTB 36: 51-54 [Abstract] [Full text]  
• Ronning, O. M., Guldvog, B. (1998). Stroke Unit Versus General Medical Wards, II: Neurological Deficits and Activities of Daily Living : A Quasi-Randomized Controlled Trial. Stroke 29: 586-590 [Abstract] [Full text]  
• Counsell, C., McDowall, M., Dennis, M., Mitchell, A., Kirckpatrick, P., Scott, J., O'Connell, J., Gray, C., Weir, C., Dyker, A., Lees, K., Murray, G. (1997). Hyperglycaemia after acute stroke. BMJ 315: 810-810 [Full text]