Stroke, Vol 22, 842-847, Copyright © 1991 by American Heart Association
PA O'Neill, I Davies, KJ Fullerton and D Bennett
We studied the relation of reactive hyperglycemia, stress hormone response,
and outcome in 23 consecutive elderly patients (median age 80 [range 75-92]
years) following an acute first stroke. The median delay from the onset of
the stroke to the first blood sample (day 0) was 9 (range 4-22) hours.
Subsequent blood samples were taken, after fasting, for the determination
of blood glucose, cortisol, catecholamine, insulin, C-peptide, glucagon,
and lactate concentrations on days 1, 2, 3, 7, 14, 30, and 90. For all 23
patients, a significant relation was found between the blood glucose
concentration and survival (p = 0.03) and the blood glucose concentration
decreased with time (p less than 0.001). There was also a significant
relation between blood glucose concentration and outcome (p = 0.02). For
the 15 patients with complete data, the major determinants of the blood
glucose concentration were the cortisol, insulin, and glucagon
concentrations (all p less than 0.001), which accounted for 42% of the
variance. When all the indexes were analyzed together by logistic
regression, only the cortisol concentration was related to outcome (p =
0.02). Hyperglycemia following a stroke probably reflects the intensity of
the stress hormone response. We have confirmed that hyperglycemia is a
predictor of outcome in persons with stroke.
ARTICLES
Stress hormone and blood glucose response following acute stroke in the elderly
University Department of Geriatric Medicine, University Hospital of South Manchester, England.
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