(Stroke. 1999;30:34-39.)
© 1999 American Heart Association, Inc.
Original Contributions |
Serum Glucose Level and Diabetes Predict Tissue Plasminogen Activator–Related Intracerebral Hemorrhage in Acute Ischemic Stroke
From the University of Texas-Houston, Department of Neurology, Stroke Program (A.M.D., L.B.M., D.W.K., T.L.C., T.H.W., J.C.G.); University of Texas-Houston, School of Public Health Coordinating Center for Clinical Trials (R.J.H.); and University of Calgary, Department of Clinical Neurosciences (W.H., A.M.B.).
Correspondence to Lewis B. Morgenstern, MD, Department of Neurology, University of Texas-Houston, 6431 Fannin, MSB 7.044, Houston, TX 77030. E-mail lmorgen{at}neuro.med.uth.tmc.edu
Background and Purpose—Five pretreatment variables (P<0.1 univariate analysis), including serum glucose (>300 mg/dL), predicted symptomatic intracerebral hemorrhage (ICH) in the National Institute of Neurological Disorders and Stroke rtPA trial. We retrospectively studied stroke patients treated <3 hours from onset with intravenous rtPA at 2 institutions to evaluate the role of these variables in predicting ICH.
Methods—Baseline characteristics, including 5 prespecified variables (age, baseline glucose, smoking status, National Institutes of Health Stroke Scale [NIHSS] score, and CT changes [>33% middle cerebral artery territory hypodensity]), were reviewed in 138 consecutive patients. Variables were evaluated by logistic regression as predictors of all hemorrhage (including hemorrhagic transformation) and symptomatic hemorrhage on follow-up CT scan. Variables significant at P<0.25 level were included in a multivariate analysis. Diabetes was substituted for glucose in a repeat analysis.
Results—Symptomatic hemorrhage rate was 9% (13 of 138). Any hemorrhage rate was 30% (42 of 138). Baseline serum glucose (5.5-mmol/L increments) was the only independent predictor of both symptomatic hemorrhage [OR, 2.26 (CI, 1.05 to 4.83), P=0.03] and all hemorrhage [OR, 2.26 (CI, 1.07 to 4.69), P=0.04]. Serum glucose >11.1 mmol/L was associated with a 25% symptomatic hemorrhage rate. Baseline NIHSS (5-point increments) was an independent predictor of all hemorrhage only [OR, 12.42 (CI, 1.64 to 94.3), P=0.01]. Univariate analysis demonstrated a trend for nonsmoking as a predictor of all hemorrhage [OR, 0.45 (CI, 0.19 to 1.08), P=0.07]. Diabetes was also an independent predictor of ICH when substituted for glucose in repeat analysis.
Conclusions—Serum glucose and diabetes were predictors of ICH in rtPA-treated patients. This novel association requires confirmation in a larger cohort.
Key Words: cerebral hemorrhage • diabetes mellitus • glucose • stroke, acute • thrombolytic therapy
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|
|
|
|
|
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|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
 Elevated Glucose Predicts Hemorrhage in rtPA-Treated Patients Journal Watch Neurology, May 1, 1999; 1999(501): 6 - 6. [Full Text]
|
|