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Ischemic stroke
Original research
Admission hyperglycemia and outcomes in large vessel occlusion strokes treated with mechanical thrombectomy
  1. Nitin Goyal1,
  2. Georgios Tsivgoulis1,2,
  3. Abhi Pandhi1,
  4. Kira Dillard1,
  5. Aristeidis H Katsanos2,3,
  6. Georgios Magoufis4,
  7. Jason J Chang1,
  8. Ramin Zand1,
  9. Daniel Hoit5,
  10. Apostolos Safouris1,4,
  11. Asim Choudhri6,
  12. Anne W Alexandrov1,7,
  13. Andrei V Alexandrov1,
  14. Adam S Arthur5,
  15. Lucas Elijovich1,5
  1. 1Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  2. 2Second Department of Neurology, ‘Attikon University Hospital’, School of Medicine, University of Athens, Athens, Greece
  3. 3International Clinical Research Center, St Anne's Hospital, Brno, Czech Republic
  4. 4Acute Stroke Unit, Metropolitan Hospital, Piraeus, Greece
  5. 5Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  6. 6Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  7. 7Australian Catholic University, Sydney, Australia
  1. Correspondence to Dr N Goyal, Department of Neurology, University of Tennessee Health Sciences Center, 855 Monroe Avenue, Suite #415, Memphis, TN 38163, USA; ngoyal{at}uthsc.edu

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.

  • Stroke
  • Thrombectomy

https://doi.org/10.1136/neurintsurg-2017-012993

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    Footnotes

    • NT and GT contributed equally to this study.

    • A portion of this study's findings have been presented at the World Stroke Conference 2016.

    • Contributors NG: study concept and design, acquisition of the data, analysis and interpretation, and critical revision of the manuscript for important intellectual content. GT: analysis and interpretation, and critical revision of the manuscript for important intellectual content. AP and KD: acquisition of the data and critical revision of the manuscript for important intellectual content. AHK, GM, JJC, RZ, DH, AS, AC, AWA, AVA, and ASA: critical revision of the manuscript for important intellectual content. LE: study concept and design, acquisition of the data, and critical revision of the manuscript for important intellectual content.

    • Competing interests None declared.

    • Ethics approval The study was approved by the institutional review board of the University of Tennessee (acute stroke registry 10-01003-XP).

    • Provenance and peer review Not commissioned; externally peer reviewed.