Association of Admission Blood Glucose and Outcome in Patients Treated With Intravenous Thrombolysis
Association of Admission Blood Glucose and Outcome in Patients Treated With Intravenous Thrombolysis
复制标题
DOI：
10.1001/archneurol.2010.210
复制
发表时间：
2010-09-01
影响因子：
--
通讯作者：
Toni, Danilo
中科院分区：
文献类型：
--
作者：
Ahmed, Niaz;Davalos, Antoni;Toni, Danilo
目的：确定接受溶栓治疗的缺血性中风患者入院时血糖与结局之间的相关性。设计：一项前瞻性、开放性、跨国、观察性研究。设置：一项正在进行的基于互联网、学术驱动的交互式溶栓登记。患者：2002年至2007年间，SITS-ISTR记录了16049例患者。主要结局指标：入院时记录血糖。血糖分为以下类别：低于80、80 -120（参考范围）、121-140、141-160、161-180、181-200和高于200 mg/dL。结局为死亡率和独立性3个月时（改良兰金量表评分为0-2）和症状性脑出血（SICH）（国立卫生研究院卒中量表24小时内恶化>=分和2型脑实质出血）。在多变量分析中，血糖作为连续变量与较高的死亡率独立相关（P < .001），独立性较低（P < .001），SICH风险增加（P = .005）。血糖大于120 mg/dL作为一个分类变量与死亡率显著增高相关（比值比[OR]，1.24; 95%置信区间[Cl]，1.07-1.44; P = 0.004），独立性的比值较低（OR，0.58; 95%CI，0.48-0.70; P < .001），与参考水平相比，血糖从181到200 mg/dL与SICH风险增加相关（OR，2.86; 95%CI，1.69-4.83; P < .001）。除死亡率外，糖尿病患者（17%）和无糖尿病史患者的血糖和结局之间的相关性趋势相似（P = .23）和SICH（P = 0.06），其中糖尿病患者的相关性无统计学意义。结论：入院时高血糖是卒中/溶栓后不良结局的独立预测因子，尽管SICH率在达到180 mg/dL之前没有显著增加。这些结果表明，严格控制血糖可能是指在超急性期后溶栓。需要随机试验数据。
Objective: To determine the association between admission blood glucose and outcome in ischemic stroke patients treated with thrombolysis.Design: A prospective, open, multinational, observational study.Setting: An ongoing Internet-based, academic-driven, interactive thrombolysis register.Patients: Between 2002 and 2007, 16 049 patients were recorded in the SITS-ISTR.Main Outcome Measure: Blood glucose was recorded at admission. Blood glucose was divided into the following categories: less than 80,80-120 (reference range), 121-140, 141-160, 161-180, 181-200, and greater than 200 mg/dL. Outcomes were mortality and independence (modified Rankin Scale score of 0-2) at 3 months and symptomatic intracerebral hemorrhage (SICH) (National Institutes of Health Stroke Scale deterioration >= points within 24 hours and type 2 parenchymal hemorrhage).Results: In multivariable analysis, blood glucose as a continuous variable was independently associated with a higher mortality (P < .001), lower independence (P < .001), and an increased risk of SICH (P = .005). Blood glucose greater than 120 mg/dL as a categorical variable was associated with a significantly higher odds for mortality (odds ratio [OR], 1.24; 95% confidence interval [Cl], 1.07-1.44; P = .004) and a lower odds for independence (OR, 0.58; 95% CI, 0.48-0.70; P < .001), and blood glucose from 181 to 200 mg/dL was associated with an increased risk of SICH (OR, 2.86; 95% CI, 1.69-4.83; P < .001) compared with the reference level. The trends of associations between blood glucose and outcomes were similar in patients with diabetes (17%) or without such history, except for mortality (P = .23) and SICH (P = .06) in which the association was not statistically significant in patients with diabetes.Conclusions: Admission hyperglycemia was an independent predictor for poor outcome after stroke/thrombolysis, though SICH rates did not increase significantly until reaching 180 mg/dL. These results suggest that tight control of blood glucose may be indicated in the hyperacute phase following thrombolysis. Randomized trial data are needed.