Hyperglycemia predicts unfavorable outcomes in acute ischemic stroke patients treated with intravenous thrombolysis among a Chinese population: A prospective cohort study

Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study Group

研究成果: 雜誌貢獻文章

3 引文 (Scopus)

摘要

Background and purpose: Poorly controlled blood glucose was reported to cause deterioration of acute ischemic stroke. In this study, we investigated whether an elevated admission serum glucose level in the 3-h time window of intravenous thrombolysis for acute ischemic stroke determined poor functional outcomes among Chinese population. Methods: This was a prospective cohort study. From December 1, 2004 to December 31, 2016, a total of 2370 patients were enrolled and categorized into two cohorts by blood glucose levels of ≥200 and <200 mg/dl in the 3 h after stroke onset. The primary objective was to determine whether admission hyperglycemia increased major disability and death at 30 and 90 days, which was defined by a modified Rankin Scale of 3–6. The secondary objective was to determine whether admission hyperglycemia increased the symptomatic intracranial hemorrhage (SICH) at 90 days. The number needed to harm (NNH) and patient expected event rate (PEER) were evaluated for both the primary and secondary objectives. Results: The primary outcome occurred in 216 of 305 patients (70.8%) in the blood glucose ≥200 mg/dl cohort and in 951 of 1587 patients (59.9%) in the blood glucose <200 mg/dl cohort at 30 days, and in 191 of 287 patients (66.6%) in the blood glucose ≥200 mg/dl cohort and in 827 of 1517 patients (54.5%) in the blood glucose <200 mg/dl cohort at 90 days. Patients with admission hyperglycemia had significantly increased major disability and death at 30 (adjusted relative risk (RR): 1.194 [1.073–1.329], p = 0.0012) and 90 days (adjusted RR: 1.203 [1.079–1.340], p = 0.0008). Admission hyperglycemia increased the risk of the occurrence of SICH by nearly 2-fold (adjusted RR: 1.891 [0.977–3.657], p = 0.0585 with the SITS-MOST criteria and adjusted RR: 1.884 [1.138–3.121], p = 0.0139 with the NINDS criteria). NNH values of admission hyperglycemia in major disability and death at 30 and 90 days were 9 and 10, and NNH values of SICH by the SITS-MOST NINDS criteria were 44 and 34, respectively. Conclusions: The study evidenced the association and temporal relationship of admission hyperglycemia causing deterioration of functional outcomes and increased SICH among Chinese population with acute ischemic stroke treated with intravenous thrombolysis.
原文英語
頁(從 - 到)195-202
頁數8
期刊Journal of the Neurological Sciences
388
DOIs
出版狀態已發佈 - 五月 15 2018

指紋

Hyperglycemia
Blood Glucose
Cohort Studies
Intracranial Hemorrhages
Stroke
Prospective Studies
4-Acetamido-4'-isothiocyanatostilbene-2,2'-disulfonic Acid
National Institute of Neurological Disorders and Stroke
Population
Patient Harm
Patient Admission
Glucose
Serum

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

引用此文

Hyperglycemia predicts unfavorable outcomes in acute ischemic stroke patients treated with intravenous thrombolysis among a Chinese population : A prospective cohort study. / Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study Group.

於: Journal of the Neurological Sciences, 卷 388, 15.05.2018, p. 195-202.

研究成果: 雜誌貢獻文章

@article{92a143bb0b0a434bb4a2821503aba350,
title = "Hyperglycemia predicts unfavorable outcomes in acute ischemic stroke patients treated with intravenous thrombolysis among a Chinese population: A prospective cohort study",
abstract = "Background and purpose: Poorly controlled blood glucose was reported to cause deterioration of acute ischemic stroke. In this study, we investigated whether an elevated admission serum glucose level in the 3-h time window of intravenous thrombolysis for acute ischemic stroke determined poor functional outcomes among Chinese population. Methods: This was a prospective cohort study. From December 1, 2004 to December 31, 2016, a total of 2370 patients were enrolled and categorized into two cohorts by blood glucose levels of ≥200 and <200 mg/dl in the 3 h after stroke onset. The primary objective was to determine whether admission hyperglycemia increased major disability and death at 30 and 90 days, which was defined by a modified Rankin Scale of 3–6. The secondary objective was to determine whether admission hyperglycemia increased the symptomatic intracranial hemorrhage (SICH) at 90 days. The number needed to harm (NNH) and patient expected event rate (PEER) were evaluated for both the primary and secondary objectives. Results: The primary outcome occurred in 216 of 305 patients (70.8{\%}) in the blood glucose ≥200 mg/dl cohort and in 951 of 1587 patients (59.9{\%}) in the blood glucose <200 mg/dl cohort at 30 days, and in 191 of 287 patients (66.6{\%}) in the blood glucose ≥200 mg/dl cohort and in 827 of 1517 patients (54.5{\%}) in the blood glucose <200 mg/dl cohort at 90 days. Patients with admission hyperglycemia had significantly increased major disability and death at 30 (adjusted relative risk (RR): 1.194 [1.073–1.329], p = 0.0012) and 90 days (adjusted RR: 1.203 [1.079–1.340], p = 0.0008). Admission hyperglycemia increased the risk of the occurrence of SICH by nearly 2-fold (adjusted RR: 1.891 [0.977–3.657], p = 0.0585 with the SITS-MOST criteria and adjusted RR: 1.884 [1.138–3.121], p = 0.0139 with the NINDS criteria). NNH values of admission hyperglycemia in major disability and death at 30 and 90 days were 9 and 10, and NNH values of SICH by the SITS-MOST NINDS criteria were 44 and 34, respectively. Conclusions: The study evidenced the association and temporal relationship of admission hyperglycemia causing deterioration of functional outcomes and increased SICH among Chinese population with acute ischemic stroke treated with intravenous thrombolysis.",
keywords = "Acute ischemic stroke, Admission hyperglycemia, Cohort analysis, Glucose levels, Stroke outcomes, Tissue plasminogen activator",
author = "{Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study Group} and Lin, {Sheng Feng} and Chao, {A. Ching} and Hu, {Han Hwa} and Lin, {Ruey Tay} and Chen, {Chih Hung} and Lung Chan and Lin, {Huey Juan} and Yu Sun and Lin, {Yung Yang} and Chen, {Po Lin} and Lin, {Shinn Kuang} and Sun, {Ming Hui} and Wei, {Cheng Yu} and Lin, {Yu Te} and Lee, {Jiunn Tay} and Bai, {Chi Huey}",
year = "2018",
month = "5",
day = "15",
doi = "10.1016/j.jns.2018.03.022",
language = "English",
volume = "388",
pages = "195--202",
journal = "Journal of the Neurological Sciences",
issn = "0022-510X",
publisher = "Elsevier",

}

TY - JOUR

T1 - Hyperglycemia predicts unfavorable outcomes in acute ischemic stroke patients treated with intravenous thrombolysis among a Chinese population

T2 - A prospective cohort study

AU - Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study Group

AU - Lin, Sheng Feng

AU - Chao, A. Ching

AU - Hu, Han Hwa

AU - Lin, Ruey Tay

AU - Chen, Chih Hung

AU - Chan, Lung

AU - Lin, Huey Juan

AU - Sun, Yu

AU - Lin, Yung Yang

AU - Chen, Po Lin

AU - Lin, Shinn Kuang

AU - Sun, Ming Hui

AU - Wei, Cheng Yu

AU - Lin, Yu Te

AU - Lee, Jiunn Tay

AU - Bai, Chi Huey

PY - 2018/5/15

Y1 - 2018/5/15

N2 - Background and purpose: Poorly controlled blood glucose was reported to cause deterioration of acute ischemic stroke. In this study, we investigated whether an elevated admission serum glucose level in the 3-h time window of intravenous thrombolysis for acute ischemic stroke determined poor functional outcomes among Chinese population. Methods: This was a prospective cohort study. From December 1, 2004 to December 31, 2016, a total of 2370 patients were enrolled and categorized into two cohorts by blood glucose levels of ≥200 and <200 mg/dl in the 3 h after stroke onset. The primary objective was to determine whether admission hyperglycemia increased major disability and death at 30 and 90 days, which was defined by a modified Rankin Scale of 3–6. The secondary objective was to determine whether admission hyperglycemia increased the symptomatic intracranial hemorrhage (SICH) at 90 days. The number needed to harm (NNH) and patient expected event rate (PEER) were evaluated for both the primary and secondary objectives. Results: The primary outcome occurred in 216 of 305 patients (70.8%) in the blood glucose ≥200 mg/dl cohort and in 951 of 1587 patients (59.9%) in the blood glucose <200 mg/dl cohort at 30 days, and in 191 of 287 patients (66.6%) in the blood glucose ≥200 mg/dl cohort and in 827 of 1517 patients (54.5%) in the blood glucose <200 mg/dl cohort at 90 days. Patients with admission hyperglycemia had significantly increased major disability and death at 30 (adjusted relative risk (RR): 1.194 [1.073–1.329], p = 0.0012) and 90 days (adjusted RR: 1.203 [1.079–1.340], p = 0.0008). Admission hyperglycemia increased the risk of the occurrence of SICH by nearly 2-fold (adjusted RR: 1.891 [0.977–3.657], p = 0.0585 with the SITS-MOST criteria and adjusted RR: 1.884 [1.138–3.121], p = 0.0139 with the NINDS criteria). NNH values of admission hyperglycemia in major disability and death at 30 and 90 days were 9 and 10, and NNH values of SICH by the SITS-MOST NINDS criteria were 44 and 34, respectively. Conclusions: The study evidenced the association and temporal relationship of admission hyperglycemia causing deterioration of functional outcomes and increased SICH among Chinese population with acute ischemic stroke treated with intravenous thrombolysis.

AB - Background and purpose: Poorly controlled blood glucose was reported to cause deterioration of acute ischemic stroke. In this study, we investigated whether an elevated admission serum glucose level in the 3-h time window of intravenous thrombolysis for acute ischemic stroke determined poor functional outcomes among Chinese population. Methods: This was a prospective cohort study. From December 1, 2004 to December 31, 2016, a total of 2370 patients were enrolled and categorized into two cohorts by blood glucose levels of ≥200 and <200 mg/dl in the 3 h after stroke onset. The primary objective was to determine whether admission hyperglycemia increased major disability and death at 30 and 90 days, which was defined by a modified Rankin Scale of 3–6. The secondary objective was to determine whether admission hyperglycemia increased the symptomatic intracranial hemorrhage (SICH) at 90 days. The number needed to harm (NNH) and patient expected event rate (PEER) were evaluated for both the primary and secondary objectives. Results: The primary outcome occurred in 216 of 305 patients (70.8%) in the blood glucose ≥200 mg/dl cohort and in 951 of 1587 patients (59.9%) in the blood glucose <200 mg/dl cohort at 30 days, and in 191 of 287 patients (66.6%) in the blood glucose ≥200 mg/dl cohort and in 827 of 1517 patients (54.5%) in the blood glucose <200 mg/dl cohort at 90 days. Patients with admission hyperglycemia had significantly increased major disability and death at 30 (adjusted relative risk (RR): 1.194 [1.073–1.329], p = 0.0012) and 90 days (adjusted RR: 1.203 [1.079–1.340], p = 0.0008). Admission hyperglycemia increased the risk of the occurrence of SICH by nearly 2-fold (adjusted RR: 1.891 [0.977–3.657], p = 0.0585 with the SITS-MOST criteria and adjusted RR: 1.884 [1.138–3.121], p = 0.0139 with the NINDS criteria). NNH values of admission hyperglycemia in major disability and death at 30 and 90 days were 9 and 10, and NNH values of SICH by the SITS-MOST NINDS criteria were 44 and 34, respectively. Conclusions: The study evidenced the association and temporal relationship of admission hyperglycemia causing deterioration of functional outcomes and increased SICH among Chinese population with acute ischemic stroke treated with intravenous thrombolysis.

KW - Acute ischemic stroke

KW - Admission hyperglycemia

KW - Cohort analysis

KW - Glucose levels

KW - Stroke outcomes

KW - Tissue plasminogen activator

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U2 - 10.1016/j.jns.2018.03.022

DO - 10.1016/j.jns.2018.03.022

M3 - Article

AN - SCOPUS:85044447456

VL - 388

SP - 195

EP - 202

JO - Journal of the Neurological Sciences

JF - Journal of the Neurological Sciences

SN - 0022-510X

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