MedWire News: Post-stroke capillary glucose levels above a certain threshold are indicative of a poor outcome, even if hyperglycemia occurs up to 2 days after the onset of stroke, research suggests.
“Evidence is accumulating regarding the prognostic influence of hyperglycemia in patients with acute ischemic stroke,” note Blanca Fuentes (Hospital Universitario La Paz, Madrid, Spain) and co-authors. “However, the level associated with poor outcome is unknown,” they add.
Moreover, previous studies have tended to focus on hyperglycemia on admission to hospital only, despite evidence that glucose levels can fluctuate in stressful situations, for example.
As part of the GLycemia in Acute Stroke (GLIAS) study, Fuentes and co-workers assessed 476 patients with ischemic stroke, all of whom were admitted to hospital within 24 hours from stroke onset. Capillary finger-prick glucose levels and stroke severity were assessed on admission, and again three times per day during the first 48 hours after stroke onset. Stroke severity was also evaluated 3 months later using the modified Rankin Scale.
Fuentes et al found that the maximum capillary glucose level at any point during the first 48 hours was significantly predictive of poor stroke outcome at 3 months.
The team calculated that, after adjustment for age, diabetes, capillary glucose levels on admission, infarct volume, and baseline stroke severity, 155 mg/dl was the optimum cut-off value. Capillary glucose levels above this threshold conferred a 2.7-fold increase in the odds for a poor outcome at three months, and a three-fold increase in the risk of death at three months.
In summary, “hyperglycemia ≥155 mg/dl at any time within the first 48 hours from stroke onset, and not only the isolated value of admission glycemia, is associated with poor outcome independently of stroke severity, infarct volume, diabetes, or age,” the researchers conclude in the journal Stroke.
“This study has implications for future research because it gives a cutoff point of capillary glucose level that could serve as a reference in future interventional trials.”
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