Acute blood glucose level and outcome from ischemic stroke

Objective: To study the relation between acute blood glucose level and outc ome from ischemic stroke. Background: Hyperglycemia may augment acute ische mic brain injury and increase the risk of hemorrhagic transformation of the infarct. Methods: The authors analyzed the relation between admission bloo d glucose level (within 24 hours from ischemic stroke onset) and clinical o utcome 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 st roke. Very favorable outcome was defined as as a Glasgow Outcome Scale scor e of 1 and a modified Barthel index of 19 or 20. Neurologic improvement at 3 months was defined as a decrease by greater than or equal to 4 points on the NIH Stroke Scale compared with baseline or a final score of 0. Hemorrha gic transformation of infarct was assessed within 10 days after onset of st roke with repeat cerebral CT. Stroke subtype as lacunar or nonlacunar (athe rothromboembolic, cardioembolic, and other or undetermined etiology) was cl assified by one investigator after completion of stroke evaluation accordin g to study protocol. Results: In all strokes combined (p = 0.03) and in non lacunar strokes (p = 0.02), higher admission blood glucose levels were asso ciated with worse outcome at 3 months according to multivariate logistic re gression analysis adjusted for stroke severity, diabetes mellitus, and othe r vascular risks. In lacunar strokes, the relationship between acute blood glucose level and outcome was related to treatment. In the placebo group, h igher admission blood glucose levels were associated with better outcome at 3 months. However, in the active drug group, as the glucose level increase d from 50 to 150 mg/dL, the probability of a very favorable outcome decreas ed 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 transformati on of infarcts or with neurologic improvement at 3 months. Conclusions: Dur ing 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.