The Influence of Hyperglycemia on Outcome of Cerebral Infarction
- David B. Matchar, MD;
- George W. Divine, PhD;
- Albert Heyman, MD; and
- John R. Feussner, MD
Abstract
▪ Objective: To determine whether hyperglycemia in the acute stroke period is associated with worse survival and functional outcome after accounting for acute stress response and chronic hyperglycemia.
▪ Design: Prospective, county-wide, multicenter cohort study.
▪ Setting: A community hospital, a university hospital, and a Veterans Affairs hospital.
▪ Patients: A cohort of 146 patients hospitalized with new atherothrombotic stroke.
▪ Measurements: Admission blood glucose concentration, demographic characteristics of patients, 24-hour urinary catecholamine, serum cortisol, and glycosylated hemoglobin levels; outcomes included mortality and functional outcome (Barthel index and Fugl-Meyer score) at 5, 30, 90, and 180 days after stroke.
▪ Results: Of the 996 patients with possible acute stroke who were screened, 146 (15%) were eligible for and consented to participate in the study; in most cases, exclusion from study was based on the absence of acute, atherothrombotic stroke. Overall, no evidence was found of a significant univariate association between admission blood glucose level and survival (relative risk, 1.02; 95% Cl, 0.94 to 1.09) or functional outcome (univariate regression coefficient for adjusted Fugl-Meyer score at day 30, - 0.36; Cl, - 1.08 to 0.27). This absence of an association persisted after adjustment for significant predictors of outcome in a multivariate model.
▪ Conclusions: These data do not support an association between level of glycemia and outcome from acute stroke.
Article and Author Information
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From Duke University and the Durham Veterans Affairs Medical Center, Durham, North Carolina. For current author addresses, see end of text.
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Grant Support: In part by grant NS 06233 from the National Institute for Neurological Diseases and Stroke.
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Requests for Reprints: David B. Matchar, MD, Center for Health Policy Research and Education, Suite 125, Old Chemistry Building, Duke University, Durham, NC 27706.
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Current Author Addresses: Dr. Matchar: Center for Health Policy Research and Education, Suite 125, Old Chemistry Building, Duke University, Durham, NC 27706.
Dr. Divine: Henry Ford Health System, Division of Biostatistics, Research Epidemiology and Computing, 23725 Northwestern, Southfield, MI 48075.
Dr. Heyman: Division of Neurology, Department of Medicine, Box 3240, Duke University Medical Center, Durham, NC 27710.
Dr. Feussner: Division of General Internal Medicine, Department of Medicine, Box 3240, Duke University Medical Center, Durham, NC 27710.
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