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(Stroke. 2009;40:562.)
© 2009 American Heart Association, Inc.

Original Contributions

The Prognostic Value of Capillary Glucose Levels in Acute Stroke

The GLycemia in Acute Stroke (GLIAS) Study

Blanca Fuentes, MD, PhD; José Castillo, MD, PhD; Belén San José; Rogelio Leira, MD, PhD; Joaquín Serena, MD, PhD; José Vivancos, MD, PhD; Antonio Dávalos, MD, PhD; Antonio Gil Nuñez, MD, PhD; José Egido, MD; Exuperio Díez-Tejedor, MD, PhD for the Stroke Project of the Cerebrovascular Diseases Study Group, Spanish Society of Neurology

From the Stroke Unit, Department of Neurology (E.D-T., B.F.), Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain; the Stroke Unit, Department of Neurology (J.C., R.L.), Hospital Clínico Universitario, Santiago de Compostela, Universidad de Santiago de Compostela, Santiago de Compostela, Spain; the Department of Biostatistics (B.S.J.), Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid Spain; the Stroke Unit, Department of Neurology (J.S.), Hospital Josep Trueta, Gerona, Spain; the Stroke Unit, Department of Neurology (J.V.), Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain; the Stroke Unit, Department of Neurology (A.D.), Hospital Germans Trias i Pujol, Badalona, Spain; the Stroke Unit, Department of Neurology (A.G.N.), Hospital Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain; and the Stroke Unit, Department of Neurology (J.E.), Hospital Clínico Universitario San Carlos, Universidad Complutense, Madrid, Spain.

Correspondence to Exuperio Díez-Tejedor, MD, PhD, Department of Neurology, University Hospital La Paz, UAM. Paseo de la Castellana, 261, 28046 Madrid, Spain. E-mail ediez{at}meditex.es

Background and Purpose— Evidence is accumulating regarding the prognostic influence of hyperglycemia in patients with acute ischemic stroke. However, the level associated with poor outcome is unknown. Our objectives were to establish the capillary glucose threshold with the highest predictive accuracy of poor outcome and to evaluate its hypothetical value in influencing functional outcome by adjusting for other well-known prognostic factors in acute stroke.

Methods— The authors conducted a multicenter, prospective, and observational cohort study of 476 patients with ischemic stroke within less than 24 hours from stroke onset. Capillary finger-prick glucose and stroke severity were determined on admission and 3 times a day during the first 48 hours. Poor outcome (modified Rankin Scale >2) was evaluated at 3 months.

Results— The receiver operating characteristic curves showed the predictive value of maximum capillary glucose at any time within the first 48 hours with an area under the curve of 0.656 (95% CI, 0.592 to 0.720; P<0.01) and pointed to 155 mg/dL as the optimal cutoff level for poor outcome at 3 months (53% sensitivity; 73% specificity). This point was associated with a 2.7-fold increase (95% CI, 1.42 to 5.24) in the odds of poor outcome after adjustment for age, diabetes, capillary glucose on admission, infarct volume, and baseline stroke severity and with a 3-fold increase in the risk of death at 3 months (hazard ratio, 3.80; 95% CI, 1.79 to 8.10).

Conclusions— Hyperglycemia 155 mg/dL at any time within the first 48 hours from stroke onset, and not only the isolated value of admission glycemia, is associated with poor outcome independently of stroke severity, infarct volume, diabetes, or age.

Key Words: acute stroke • hyperglycemia • outcome • stroke care

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