Correlation between hyperglycemia at admission and outcome after intravenous thrombolysis in patients with acute ischemic stroke / 国际脑血管病杂志

ABSTRACT

Objective To investigate the effect of blood glucose levels at admission on the outcomes and hemorrhagic transformation in patients with acute ischemic stroke (AIS) after intravenous thrombolysis. Methods From December 2013 to January 2017, patients with AIS treated with intravenous thrombolysis at the Department of Neurology, Xuzhou Central Hospital were enrolled retrospectively. According to the blood glucose levels on admission, they were divided into non-hyperglycemic group ( ≤8 mmol/L ) and hyperglycemic group ( > 8 mmol/L). The functional outcome was assessed with the modified Rankin Scale score at 90 d after onset, and 0-2 was defined as good outcome and > 2 was defined as poor outcome. From 24 h to 7 d after treatment, CT scan was performed again to determine whether there was intracranial hemorrhage or not. Multivariate logistic regression analysis was used to identify the independent influencing factors of outcomes after intravenous thrombolysis. Results A total of 323 patients with AIS were enrolled, including 237 (73. 4％) in the non-hyperglycemic group and 86 (26. 6％) in the hyperglycemic group; 238 (73. 7％) in the good outcome group, and 85 (26. 3％) in the poor outcome group; 25 (7. 7％) in the hemorrhagic transformation group, and 298 (92. 3％) in the non-hemorrhagic transformation group. Univariate analysis showed that there were significant differences in the proportions of patients with ischemic heart disease, atrial fibrillation, past history of stroke or TIA, as well as age, baseline National Institutes of Health Stroke Scale (NIHSS) score, and baseline blood glucose between the poor outcome group and the good outcome group (all P < 0. 05). There were significant differences in the proportion of hypertensive patients and baseline NIHSS score between the hemorrhagic transformation group and the non- hemorrhagic transformation group ( all P < 0. 05 ). Multivariate logistic regression analysis showed that hyperglycemia at admission (odds ratio [OR] 2. 239, 95％ confidence interval [CI] 1. 210-4. 143; P = 0. 010)and baseline NIHSS score (OR 3. 528, 95％ CI 2. 451-5. 078; P < 0. 001) were the independent influencing factors of poor outcome; hypertension (OR 0. 410, 95％ CI 0. 173-0. 972; P = 0. 043 ) and baseline NIHSS score (OR 2. 283, 95％ CI 1. 382-3. 772, P = 0. 001 ) were the independent influencing factors of hemorrhagic transformation. Conclusion Hyperglycemia at admission was an independent risk factor for poor outcome in patients with AIS after intravenous thrombolytic therapy, but it was not associated with the risk of hemorrhagic transformation.