Association of Acute and Chronic Hyperglycemia With Acute Ischemic Stroke Outcomes Post-Thrombolysis: Findings From Get With The Guidelines-Stroke.
Association of Acute and Chronic Hyperglycemia With Acute Ischemic Stroke Outcomes Post-Thrombolysis: Findings From Get With The Guidelines-Stroke.
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DOI：
10.1161/jaha.115.002193
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发表时间：
2015-09-25
影响因子：
5.4
通讯作者：
Schwamm L
中科院分区：
文献类型：
--
作者：
Masrur S;Cox M;Bhatt DL;Smith EE;Ellrodt G;Fonarow GC;Schwamm L
高血压与急性缺血性卒中（AIS）患者的不良结局相关，并可能影响组织纤溶酶原激活剂（tPA）治疗后的结局。我们试图分析急性和慢性高血糖症与tPA治疗患者临床结局的相关性。我们在《指南指南-卒中》中确定了2009年至2013年接受tPA治疗的1408家临床试验机构的58265例AIS患者。入院时急性高血糖症定义为血糖水平>140 mg/dL。慢性高血糖定义为血浆糖化血红蛋白（HbA 1c）> 6.5%。使用logistic回归分析tPA后结局。在糖尿病和非糖尿病患者中，血糖>140 mg/dL和HbA 1c>6.5与更差的临床结局（症状性颅内出血[sICH]、危及生命的出血、住院死亡率和住院时间）相关。在有糖尿病病史的患者中，入院血糖升高至200 mg/dL与血糖每升高10 mg/dL住院死亡率（aOR，1.07）和sICH（aOR，1.05）的校正比值比（aOR）升高相关。HbA 1c升高至8%与HbA 1c每升高1%，院内死亡率（aOR，1.19）和sICH（aOR，1.16）的几率增加相关。在没有糖尿病病史的患者中观察到类似的结果。在血糖水平高于200 mg/dL或HbA 1c>8时，不良结局没有进一步增加。急性和慢性高血糖症均与tPA治疗的AIS患者的死亡率增加和临床结局恶化相关。需要对照试验来确定急性纠正高血糖是否能改善溶栓后的结局。
Hyperglycemia has been associated with adverse outcomes in patients with acute ischemic stroke (AIS) and may influence outcomes after tissue plasminogen activator (tPA). We sought to analyze the association of acute and chronic hyperglycemia on clinical outcomes in tPA‐treated patients. We identified 58 265 AIS patients from 1408 sites who received tPA from 2009 to 2013 in Get With The Guidelines‐Stroke. Acute hyperglycemia at admission was defined as a plasma glucose level >140 mg/dL. Chronic hyperglycemia was defined by plasma glycosylated hemoglobin (HbA1c) >6.5%. Post‐tPA outcomes were analyzed using logistic regression. Blood glucose >140 mg/dL and HbA1c >6.5 were associated with worse clinical outcomes (symptomatic intracranial hemorrhage [sICH], life‐threatening hemorrhage, and in‐hospital mortality and length of stay) in diabetic and nondiabetic patients. Among patients with documented history of diabetes, increasing admission glucose up to 200 mg/dL was associated with increased adjusted odds ratio (aOR) of in‐hospital mortality (aOR, 1.07) and sICH (aOR, 1.05) per 10 mg/dL increase in blood glucose. Increasing HbA1C to 8% was associated with increased odds of in‐hospital mortality (aOR, 1.19) and sICH (aOR, 1.16) per 1% increase in HbA1c. Similar findings were observed in patients without a documented history of diabetes. There was no further increase in poor outcomes above the blood glucose level of 200 mg/dL or HbA1c >8. Acute and chronic hyperglycemia are both associated with increased mortality and worse clinical outcomes in AIS patients treated with tPA. Controlled trials are needed to determine whether acute correction of hyperglycemia can improve outcomes after thrombolysis.