IS HYPERGLYCEMIA AN INDEPENDENT PREDICTOR OF POOR OUTCOME AFTER ACUTESTROKE - RESULTS OF A LONG-TERM FOLLOW-UP-STUDY

Objective: To determine whether raised plasma glucose concentration in dependently influences outcome after acute stroke or is a stress respo nse reflecting increased stroke severity. Design: Long term follow up study of patients admitted to an acute stroke unit. Setting Western In firmary, Glasgow. Subjects: 811 patients with acute stroke confirmed b y computed tomography. Analysis was restricted to the 750 non-diabetic patients. Main outcome measures: Survival time and placement three mo nths after stroke. Results: 645 patients (86%) had ischaemic stroke an d 105 patients (14%) haemorrhagic stroke. Cox's proportional hazards m odelling with stratification according to Oxfordshire Community Stroke Project categories identified increased age (relative hazard 1.36 per decade; 95% confidence interval 1.21 to 1.53), haemorrhagic stroke (r elative hazard 1.67; 1.22 to 2.28), time to resolution of symptoms > 7 2 hours (relative hazard 2.15; 1.15 to 4.05), and hyperglycaemia (rela tive hazard 1.87; 1.43 to 2.45) as predictors of mortality. The effect of glucose concentration on survival nas greatest in the first month. Conclusions: Plasma glucose concentration above 8 mmol/l after acute stroke predicts a poor prognosis after correcting for age, stroke seve rity, and stroke subtype. Raised plasma glucose concentration is there fore unlikely to be solely a stress response and should arguably be tr eated actively. A randomised trial is warranted.