Admission hyperglycemia and outcomes in large vessel occlusion strokes treated with mechanical thrombectomy

Journal article


Goyal, Nitin, Tsivgoulis, Georgios, Pandhi, Abhi, Dillard, Kira, Katsanos, Aristeidis H., Magoufis, Georgios, Chang, Jason J., Zand, Ramin, Hoit, Daniel, Safouris, Apostolos, Choudhri, Asim, Alexandrov, Anne W., Alexandrov, Andrei V., Arthur, Adam S. and Elijovich, Lucas. (2018). Admission hyperglycemia and outcomes in large vessel occlusion strokes treated with mechanical thrombectomy. Journal of NeuroInterventional Surgery. 10(2), pp. 112-117. https://doi.org/10.1136/neurintsurg-2017-012993
AuthorsGoyal, Nitin, Tsivgoulis, Georgios, Pandhi, Abhi, Dillard, Kira, Katsanos, Aristeidis H., Magoufis, Georgios, Chang, Jason J., Zand, Ramin, Hoit, Daniel, Safouris, Apostolos, Choudhri, Asim, Alexandrov, Anne W., Alexandrov, Andrei V., Arthur, Adam S. and Elijovich, Lucas
Abstract

Background and purpose: Higher admission serum glucose levels have been associated with poor outcomes in patients with acute ischemic stroke (AIS) treated with IV thrombolysis. We sought to evaluate the association of admission serum glucose with early outcomes of patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT).

Methods: Consecutive AIS patients due to ELVO treated with MT in three tertiary stroke centers were evaluated. The following outcomes were documented using standard definitions: symptomatic intracranial hemorrhage (sICH), complete reperfusion, mortality, functional independence (modified Rankin Scale (mRS) score of 0–2), and functional improvement (shift in mRS score) at 3 months. The association of admission serum glucose and admission hyperglycemia (>140 mg/dL) with outcomes was evaluated using univariable and multivariable binary and ordinal logistic regression models.

Results: 231 AIS patients with ELVO (mean age 62±14 years, 51% men, median admission National Institute of Health Stroke Scale score 16 points (IQR 12–21), median admission serum glucose 125 mg/dL (IQR 104–162)) were treated with MT. Admission hyperglycemia was associated with a lower likelihood of functional improvement (common OR 0.53; 95% CI 0.31 to 0.97; p=0.027) and higher odds of 3 month mortality (OR 2.76; 95% CI 1.40 to 5.44; p=0.004) in multivariable analyses adjusting for potential confounders. A 10 mg/dL increase in admission blood glucose was associated with a higher likelihood of sICH (OR 1.07; 95% CI 1.01 to 1.13; p=0.033) and 3 month mortality (OR 1.07; 95% CI 1.02 to 1.12; p=0.004) in multivariable models. There was no association between admission serum glucose or hyperglycemia and complete reperfusion.

Conclusions: Higher admission serum glucose and admission hyperglycemia are independent predictors of adverse outcomes in ELVO patients treated with MT.

Year2018
JournalJournal of NeuroInterventional Surgery
Journal citation10 (2), pp. 112-117
PublisherBMJ Publishing Group Limited
ISSN1759-8478
Digital Object Identifier (DOI)https://doi.org/10.1136/neurintsurg-2017-012993
Scopus EID2-s2.0-85046969357
Research or scholarlyResearch
Page range112-117
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All rights reserved
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Controlled
Output statusPublished
Publication dates
Print13 Mar 2017
Publication process dates
Accepted18 Feb 2017
Deposited12 May 2021
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