Stroke. 2001;32:2426-2432
doi: 10.1161/hs1001.096194
doi: 10.1161/hs1001.096194
(Stroke. 2001;32:2426.)
© 2001 American Heart Association, Inc.
Comments, Opinions, and Reviews |
Stress Hyperglycemia and Prognosis of Stroke in Nondiabetic and Diabetic Patients
A Systematic Overview
From the Department of Medicine, McMaster University, Hamilton, Ontario, Canada (S.E.C., D.H., H.C.G.); Department of Cardiology, Karolinska Hospital, Stockholm, Sweden (K.M.); and William Osler Health Center, Toronto, Ontario, Canada (P.P.).
Reprint requests to Dr S.E. Capes, HHSC-McMaster Site, Room 3V51D, 1200 Main St W, Hamilton, Ontario L8N 3Z5, Canada. E-mail scapes{at}mcmaster.ca
Background and Purpose— "Stress" hyperglycemia may be associated with increased mortality and poor recovery in diabetic and nondiabetic patients after stroke. A systematic review and meta-analysis of the literature relating acute poststroke glucose levels to the subsequent course were done to summarize and quantify this relationship.
Methods— A comprehensive literature search was done for cohort studies reporting mortality and/or functional recovery after stroke in relation to admission glucose level. Relative risks in hyperglycemic compared with normoglycemic patients with and without diabetes were calculated and meta-analyzed when possible.
Results— Thirty-two studies were identified; relative risks for prespecified outcomes were reported or could be calculated in 26 studies. After stroke of either subtype (ischemic or hemorrhagic), the unadjusted relative risk of in-hospital or 30-day mortality associated with admission glucose level >6 to 8 mmol/L (108 to 144 mg/dL) was 3.07 (95% CI, 2.50 to 3.79) in nondiabetic patients and 1.30 (95% CI, 0.49 to 3.43) in diabetic patients. After ischemic stroke, admission glucose level >6.1 to 7.0 mmol/L (110 to 126 mg/dL) was associated with increased risk of in-hospital or 30-day mortality in nondiabetic patients only (relative risk=3.28; 95% CI, 2.32 to 4.64). After hemorrhagic stroke, admission hyperglycemia was not associated with higher mortality in either diabetic or nondiabetic patients. Nondiabetic stroke survivors whose admission glucose level was >6.7 to 8 mmol/L (121 to 144 mg/dL) also had a greater risk of poor functional recovery (relative risk=1.41; 95% CI, 1.16 to 1.73).
Conclusions— Acute hyperglycemia predicts increased risk of in-hospital mortality after ischemic stroke in nondiabetic patients and increased risk of poor functional recovery in nondiabetic stroke survivors.
Key Words: hyperglycemia • glucose • meta-analysis • prognosis • stroke
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Part 4: Advanced Life Support Circulation, November 29, 2005; 112(22_suppl): III-25 - III-54. [Full Text] [PDF]
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Part 9: Stroke Circulation, November 29, 2005; 112(22_suppl): III-110 - III-104. [Full Text] [PDF]
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 D P Breen, M J G Dunn, R J Davenport, and A J Gray Epidemiology, clinical characteristics, and management of adults referred to a teaching hospital first seizure clinic Postgrad. Med. J., November 1, 2005; 81(961): 715 - 718. [Abstract] [Full Text] [PDF]
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C. L. Martin Case Study: Whose Diabetes Is It Anyway? Diabetes Self-Management After a Stroke Diabetes Spectr, October 1, 2005; 18(4): 196 - 198. [Full Text] [PDF]
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N. W. Cheung, B. Napier, C. Zaccaria, and J. P. Fletcher Hyperglycemia Is Associated With Adverse Outcomes in Patients Receiving Total Parenteral Nutrition Diabetes Care, October 1, 2005; 28(10): 2367 - 2371. [Abstract] [Full Text] [PDF]
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 R. Lattermann, G. Belohlavek, S. Wittmann, B. Fuchtmeier, and M. Gruber The Anticatabolic Effect of Neuraxial Blockade After Hip Surgery Anesth. Analg., October 1, 2005; 101(4): 1202 - 1208. [Abstract] [Full Text] [PDF]
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 B. Collier, J. Diaz Jr, R. Forbes, J. Morris Jr, A. May, J. Guy, A. Ozdas, W. Dupont, R. Miller, and G. Jensen The Impact of a Normoglycemic Management Protocol on Clinical Outcomes in the Trauma Intensive Care Unit JPEN J Parenter Enteral Nutr, September 1, 2005; 29(5): 353 - 359. [Abstract] [Full Text] [PDF]
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R.E. Anderson, K. Klerdal, T. Ivert, N. Hammar, G. Barr, and A. Owall Are even impaired fasting blood glucose levels preoperatively associated with increased mortality after CABG surgery? Eur. Heart J., August 1, 2005; 26(15): 1513 - 1518. [Abstract] [Full Text] [PDF]
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M. Ribo, C. Molina, J. Montaner, M. Rubiera, R. Delgado-Mederos, J. F. Arenillas, M. Quintana, and J. Alvarez-Sabin Acute Hyperglycemia State Is Associated With Lower tPA-Induced Recanalization Rates in Stroke Patients Stroke, August 1, 2005; 36(8): 1705 - 1709. [Abstract] [Full Text] [PDF]
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G. Van den Berghe, K. Schoonheydt, P. Becx, F. Bruyninckx, and P. J. Wouters Insulin therapy protects the central and peripheral nervous system of intensive care patients Neurology, April 26, 2005; 64(8): 1348 - 1353. [Abstract] [Full Text] [PDF]
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F. A. McAlister, S. R. Majumdar, S. Blitz, B. H. Rowe, J. Romney, and T. J. Marrie The Relation Between Hyperglycemia and Outcomes in 2,471 Patients Admitted to the Hospital With Community-Acquired Pneumonia Diabetes Care, April 1, 2005; 28(4): 810 - 815. [Abstract] [Full Text] [PDF]
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S. E. Inzucchi and J. Rosenstock Counterpoint: Inpatient Glucose Management: A premature call to arms? Diabetes Care, April 1, 2005; 28(4): 976 - 979. [Full Text] [PDF]
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R Fogelholm, K Murros, A Rissanen, and S Avikainen Admission blood glucose and short term survival in primary intracerebral haemorrhage: a population based study J. Neurol. Neurosurg. Psychiatry, March 1, 2005; 76(3): 349 - 353. [Abstract] [Full Text] [PDF]
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 T. M Conner, K. R Flesner-Gurley, and J. C Barner Hyperglycemia in the Hospital Setting: The Case for Improved Control Among Non-Diabetics Ann. Pharmacother., March 1, 2005; 39(3): 492 - 501. [Abstract] [Full Text] [PDF]
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 W. N. Kernan, C. M. Viscoli, S. E. Inzucchi, L. M. Brass, D. M. Bravata, G. I. Shulman, and J. C. McVeety Prevalence of Abnormal Glucose Tolerance Following a Transient Ischemic Attack or Ischemic Stroke Arch Intern Med, January 24, 2005; 165(2): 227 - 233. [Abstract] [Full Text] [PDF]
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American Diabetes Association Standards of Medical Care in Diabetes Diabetes Care, January 1, 2005; 28(suppl_1): S4 - S36. [Full Text] [PDF]
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R. O. Roine and P. J. Lindsberg Editorial Comment--Prime Time for Proactive Blood Glucose Control? Stroke, November 1, 2004; 35(11): 2498 - 2499. [Full Text] [PDF]
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J. Alvarez-Sabin, C. A. Molina, M. Ribo, J. F. Arenillas, J. Montaner, R. Huertas, E. Santamarina, and M. Rubiera Impact of Admission Hyperglycemia on Stroke Outcome After Thrombolysis: Risk Stratification in Relation to Time to Reperfusion Stroke, November 1, 2004; 35(11): 2493 - 2498. [Abstract] [Full Text] [PDF]
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A. G. Pittas, R. D. Siegel, and J. Lau Insulin Therapy for Critically Ill Hospitalized Patients: A Meta-analysis of Randomized Controlled Trials Arch Intern Med, October 11, 2004; 164(18): 2005 - 2011. [Abstract] [Full Text] [PDF]
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Z. T. Bloomgarden Inpatient Diabetes Control: Rationale Diabetes Care, August 1, 2004; 27(8): 2074 - 2080. [Full Text] [PDF]
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J. S. Krinsley Effect of an Intensive Glucose Management Protocol on the Mortality of Critically Ill Adult Patients Mayo Clin. Proc., August 1, 2004; 79(8): 992 - 1000. [Abstract] [PDF]
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R. Leigh, O. O. Zaidat, M. F. Suri, G. Lynch, S. Sundararajan, J. L. Sunshine, R. Tarr, W. Selman, D. M.D. Landis, and J. I. Suarez Predictors of Hyperacute Clinical Worsening in Ischemic Stroke Patients Receiving Thrombolytic Therapy Stroke, August 1, 2004; 35(8): 1903 - 1907. [Abstract] [Full Text] [PDF]
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