Hyperglycemia as An Independent Predictor of Worse Outcome in Non-diabetic Patients Presenting with Acute Ischemic Stroke
Hyperglycemia as An Independent Predictor of Worse Outcome in Non-diabetic Patients Presenting with Acute Ischemic Stroke
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DOI：
10.1007/s12028-008-9080-0
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发表时间：
2009-04-01
影响因子：
3.5
通讯作者：
Brown, Robert D., Jr.
中科院分区：
文献类型：
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作者：
Stead, Latha G.;Gilmore, Rachel M.;Brown, Robert D., Jr.
为了确定糖尿病患者和非糖尿病患者在急诊科就诊时是否存在急性缺血性中风(AIS)和血糖升高的预后差异。研究人群包括447名在症状出现24小时内就诊于急诊科的AIS患者，并在就诊时测量血糖。高血糖定义为130 mg/dl。研究结果包括梗死体积、卒中严重程度(NIH卒中评分)、功能损害(修正的Rankin评分)和90天死亡率。为了进行分析，将高血糖患者分为有糖尿病病史和无糖尿病病史的患者进行分析。与正常血糖患者相比，高血糖患者的卒中严重程度(P=0.002)和功能损害(P=0.004)显著增加。与血糖正常的患者相比，高血糖患者在90天内死亡的可能性是后者的2.3%(P<；0.001)。与高血糖和既往诊断为糖尿病的患者相比，高血糖且无糖尿病病史的患者的卒中严重程度(P<；0.001)和功能损害(P<；0.001)均显著恶化。在没有糖尿病病史的患者中，高血糖患者在90天内死亡的可能性是正常血糖患者的3.4%(P<；0.001)。相比之下，糖尿病患者的风险比为1.6(P=0.66)。表现为高血糖与AIS后明显较差的预后相关。有高血糖和无糖尿病病史的患者预后特别差，比已知的糖尿病和高血糖患者更差。
To determine if differences in outcome exist between diabetic and non-diabetic patients who present to the Emergency Department (ED) with acute ischemic stoke (AIS) and elevated blood glucose.The study population consisted of 447 consecutive patients who presented to the ED with AIS within 24 h of symptom onset and had blood glucose measured on presentation. Hyperglycemia was defined as > 130 mg/dl. Outcomes studied included infarct volume, stroke severity (NIH Stroke Scale), functional impairment (modified Rankin Score), and 90-day mortality. Patients with hyperglycemia were then stratified into those with and without a prior history of diabetes mellitus (DM) for the purposes of analysis.Patients with hyperglycemia exhibited significantly greater stroke severity (P = 0.002) and greater functional impairment (P = 0.004) than those with normoglycemia. Patients with hyperglycemia were 2.3 times more likely to be dead at 90 days compared to those with normal glucose (P < 0.001). Stroke severity (P < 0.001) and functional impairment (P < 0.001) were both significantly worse in patients with hyperglycemia and no prior history of DM, when compared to patients with hyperglycemia and previously diagnosed DM. Among the patients without a prior history of DM, patients with hyperglycemia were 3.4 times more likely to die within 90 days (P < 0.001) when compared with patients with normoglycemia. In contrast, the hazard ratio was 1.6 among the patients with DM (P = 0.66).Hyperglycemia on presentation is associated with significantly poorer outcomes following AIS. Patients with hyperglycemia and no prior history of DM have a particularly poor prognosis, worse than that for patients with known diabetes and hyperglycemia.