Abstract W P125: Glycemic Variability Should Be Associated with the Ischemic Volume Expansion and Neurological Deterioration in Acute Stroke
Background and Purpose: Several studies suggested that hyperglycemia on admission worsen the prognosis of acute stroke patients. However, it is not clear that glycemic variability in acute stroke is associated with neurological deterioration and infarct volume expansion. The purpose of this study was to clarity above issue using continuous glucose monitoring device (CGMS).
Methods: Consecutive acute stroke patients with the internal carotid artery(ICA) or middle cerebral artery(MCA) occlusion within 24 hours of stroke onset were prospectively studied. We evaluated glucose values during 72 hours after stroke onset using CGMS. All patients were classified into following three groups. Persisting hyperglycemia (PH) group had persisting hyperglycemia as glucose level above 180mg/dl, persisting normoglycemia (PN) group had persisting normoglycemia as glucose level 70mg/dl to 140mg/dl and the glucose variability (GV) group had glycemic variability as glucose level 70mg/dl to 400mg/dl during 72 hours monitoring. We compared clinical characteristics including infarct volume, and neurological change among three groups. Multivariate logistic regression analysis was performed to identify factors associated with neurological deterioration.
Results: 69 patients (male 28, median 82 years old, ICA occlusion in 11 patients) were enrolled into the present study. PH group had 10 patients, PN had 26, and GV had 33. GV group had highest baseline NIHSS score among three groups(PH;9.6, PN;12.8, GV;16.4, p=0.013).There were no differences in other factors and initial DWI volume among three groups. Follow-up infarct volume at 72 hours and infarct volume growth were largest in GV groups among three groups(PH; 53.5 and 21.5 ml, PN;69.8 and 28.8ml, and GV; 136.5 and 69.4ml, P=0.019 and P=0.015). GV group more frequently had neurological deterioration among three groups. (PH;10%, PN;0%, GV;30%, P=0.005). Multivariate logistic regression analysis demonstrated that glucose variability was an only independent factor associated with acute neurological deterioration (OR 4.671; 95%CI, 1.503-22.561, P=0.003).
Conclusion: Glycemic variability should be associated with the ischemic volume expansion, and neurological deterioration in acute stroke.
Author Disclosures: J. Uemura: None. T. Shimoyama: None. K. Shibazaki: None. N. Saji: None. K. Kimura: None.
- © 2014 by American Heart Association, Inc.