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Titre du document / Document title

Acute blood glucose level and outcome from ischemic stroke

Auteur(s) / Author(s)

Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators
BRUNO A. (1) ; BILLER J. (1) ; ADAMS H. P. (2) ; CLARKE W. R. (3) ; WOOLSON R. F. (3) ; WILLIAMS L. S. (1) ; HANSEN M. D. (3) ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1) Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, ETATS-UNIS
(2) Department of Neurology University of Iowa College of Medicine, Iowa City, IA, ETATS-UNIS
(3) Data Management Center, Department of Preventive Medicine, Division of Biostatistics, University of Iowa College of Medicine, Iowa City, IA, ETATS-UNIS

Résumé / Abstract

Objective: To study the relation between acute blood glucose level and outcome from ischemic stroke. Background: Hyperglycemia may augment acute ischemic brain injury and increase the risk of hemorrhagic transformation of the infarct. Methods: The authors analyzed the relation between admission blood glucose level (within 24 hours from ischemic stroke onset) and clinical outcome in 1,259 patients enrolled in the Trial of ORG 10172 in Acute Stroke Treatment (TOAST)-a placebo-controlled, randomized, double-blind trial to test the efficacy of a low-molecular weight heparinoid in acute ischemic stroke. Very favorable outcome was defined as a Glasgow Outcome Scale score of 1 and a modified Barthel index of 19 or 20. Neurologic improvement at 3 months was defined as a decrease by ≥4 points on the NIH Stroke Scale compared with baseline or a final score of 0. Hemorrhagic transformation of infarct was assessed within 10 days after onset of stroke with repeat cerebral CT. Stroke subtype as lacunar or nonlacunar (atherothromboembolic, cardioembolic, and other or undetermined etiology) was classified by one investigator after completion of stroke evaluation according to study protocol. Results: In all strokes combined (p = 0.03) and in nonlacunar strokes (p = 0.02), higher admission blood glucose levels were associated with worse outcome at 3 months according to multivariate logistic regression analysis adjusted for stroke severity, diabetes mellitus, and other vascular risks. In lacunar strokes, the relationship between acute blood glucose level and outcome was related to treatment. In the placebo group, higher admission blood glucose levels were associated with better outcome at 3 months. However, in the active drug group, as the glucose level increased from 50 to 150 mg/dL, the probability of a very favorable outcome decreased sharply and remained relatively unchanged as the glucose level increased further (p = 0.002, for overall effect of glucose on outcome). Acute blood glucose level was not associated with symptomatic hemorrhagic transformation of infarcts or with neurologic improvement at 3 months. Conclusions: During acute ischemic stroke hyperglycemia may worsen the clinical outcome in nonlacunar stroke, but not in lacunar stroke, and is not associated with an increased risk of hemorrhagic transformation of the infarct.

Revue / Journal Title

Neurology    ISSN  0028-3878   CODEN NEURAI 

Source / Source

1999, vol. 52, no2, pp. 280-284 (39 ref.)

Langue / Language

Anglais

Editeur / Publisher

Lippincott Williams & Wilkins, Hagerstown, MD, ETATS-UNIS  (1951) (Revue)

Mots-clés anglais / English Keywords

Ischemia

;

Brain (vertebrata)

;

Acute

;

Stroke

;

Glycemia

;

Prognosis

;

Evolution

;

Human

;

Nervous system diseases

;

Central nervous system disease

;

Cerebral disorder

;

Cerebrovascular disease

;

Cardiovascular disease

;

Vascular disease

;

Mots-clés français / French Keywords

Ischémie

;

Encéphale

;

Aigu

;

Accident cérébrovasculaire

;

Glycémie

;

Pronostic

;

Evolution

;

Homme

;

Système nerveux pathologie

;

Système nerveux central pathologie

;

Encéphale pathologie

;

Cérébrovasculaire pathologie

;

Appareil circulatoire pathologie

;

Vaisseau sanguin pathologie

;

Mots-clés espagnols / Spanish Keywords

Isquemia

;

Encéfalo

;

Agudo

;

Accidente cerebrovascular

;

Glucemia

;

Pronóstico

;

Evolución

;

Hombre

;

Sistema nervioso patología

;

Sistema nervosio central patología

;

Encéfalo patología

;

Vaso sanguíneo encéfalo patología

;

Aparato circulatorio patología

;

Vaso sanguíneo patología

;

Localisation / Location

INIST-CNRS, Cote INIST : 6345, 35400007359301.0110

Nº notice refdoc (ud4) : 1661969



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