MedWire News: It remains unclear to what extent hyperglycemia effects outcomes of patients receiving tissue plasminogen activator (tPA) for acute ischemic stroke, say US researchers.
The team examined 268 patients undergoing thrombolysis, who had initial glucose levels ranging from 62 to 507 mg/dl, and found a link between mortality and baseline glucose but not other outcomes.
“These data do not disprove the potential adverse effects of sustained hyperglycemia,” warn William Meurer (University of Michigan, Ann Arbor) and colleagues in the International Journal of Stroke.
They note that some of the associations identified in this study “are of magnitudes that conceivably may have achieved significance with a larger sample.”
However, they say that previous studies of similar size did show an association between hyperglycemia and stroke outcomes, and previous analysis of the National Institute of Stroke and Neurological Disorders tPA trial indicated that hyperglycemia is associated with poor outcomes irrespective of whether patients undergo thrombolysis.
But studies of glycemic control in stroke patients have so far failed to demonstrate improved outcomes, including a recent study showing that glycemic control did not influence final infarct size.
The researchers analyzed glucose as a continuous variable in the patients, but despite their expectations, it was not associated with survival, intracerebral hemorrhage, or functional outcome at discharge. There were also no associations when patients with and without pre-existing diabetes were analyzed separately.
There was a trend toward higher mortality with increasing baseline glucose level, such that mortality rose 1.71 fold with each 100-mg/dl increase in glucose (confidence interval 0.92–313, p=0.08). But Meuer et al say the significance of this is unclear, given the lack of effect of glucose on other outcomes.
They suggest that a pooled analysis of data from multiple studies may be revealing.
“Further studies are necessary to better define the relationship between serum glucose and outcome in tPA-treated acute ischemic stroke,” concludes the team.
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