Association of admission blood glucose and outcome in patients treated with intravenous thrombolysis: results from the Safe Implementation of Treatments in Stroke International Stroke Thrombolysis Register (SITS-ISTR).
Association of admission blood glucose and outcome in patients treated with intravenous thrombolysis: results from the Safe Implementation of Treatments in Stroke International Stroke Thrombolysis Register (SITS-ISTR).
复制标题
静脉溶栓治疗患者入院血糖与结局的关系：来自中风国际中风溶栓治疗登记册（SITS-ISTR）安全实施治疗的结果。
作者：
N. Ahmed;A. Dávalos;N. Eriksson;G. Ford;J. Glahn;M. Hennerici;R. Mikulík;M. Kaste;K. Lees;P. Lindsberg;D. Toni
目标
确定入院血糖与接受溶栓治疗的缺血性中风患者的结局之间的关联。
设计
一项前瞻性、开放性、跨国性、观察性研究。
设置
正在进行的基于互联网、学术驱动的交互式溶栓登记系统。
患者
2002 年至 2007 年间，SITS-ISTR 记录了 16 049 名患者。
主要成果衡量标准
入院时记录血糖。血糖分为以下几类：低于80、80-120（参考范围）、121-140、141-160、161-180、181-200和高于200 mg/dL。结果为 3 个月时的死亡率和独立性（改良 Rankin 量表评分为 0-2）以及症状性脑出血 (SICH)（美国国立卫生研究院卒中量表在 24 小时内恶化≥4 分和 2 型脑实质出血）。
结果
在多变量分析中，血糖作为连续变量与较高的死亡率 (P < .001)、较低的独立性 (P < .001) 和 SICH 风险增加 (P = .005) 独立相关。作为分类变量，血糖大于 120 mg/dL 与死亡率显着升高（比值比 [OR]，1.24；95% 置信区间 [CI]，1.07-1.44；P = 0.004）和较低的独立几率（OR，0.58；95% CI，0.48-0.70；P < .001）和血糖相关。与参考水平相比，从 181 至 200 mg/dL 与 SICH 风险增加相关（OR，2.86；95% CI，1.69-4.83；P < .001）。在糖尿病患者 (17%) 或无糖尿病史的患者中，血糖与结局之间的关联趋势相似，但死亡率 (P = .23) 和 SICH (P = .06) 除外，其中这种关联在糖尿病患者中不具有统计学意义。
结论
入院高血糖是卒中/溶栓后不良结局的独立预测因素，尽管 SICH 发生率直到达到 180 mg/dL 才显着增加。这些结果表明，在溶栓后的超急性期可能需要严格控制血糖。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 ≥4 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 [CI], 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.