Impact of varying levels of hyperglycemia on clinicoradiographic outcomes after endovascular reperfusion treatment

Sci Rep. 2018 Jun 29;8(1):9832. doi: 10.1038/s41598-018-28175-6.

Abstract

We evaluated the effects of admission hyperglycemia with different cut-off levels on 3-month outcomes, infarct growth, and hemorrhagic transformation in acute stroke patients with large artery occlusion of anterior circulation who received endovascular treatment (EVT). Between January 2011 and May 2016, patients that underwent EVT with pre-procedural and post-procedural diffusion-weighted imaging were identified from a multicenter registry. Normoglycemia was defined as a glucose level ≤ 110 mg/dL, moderate hyperglycemia as >110 and ≤170 mg/dL, and overt hyperglycemia as >170 mg/dL. Its effects on poor outcomes (3-month modified Rankin Scale score 3-6), infarct growth, and parenchymal hematoma type 2 were analyzed. Of 720 patients encountered, 341 patients were eligible. There was a statistically significant difference in glycated hemoglobin levels between the normoglycemia/moderate hyperglycemia and overt hyperglycemia groups (p < 0.001). Moderate hyperglycemia (odds ratio 2.37 [95% confidence interval 1.26-4.45], p = 0.007) and overt hyperglycemia (2.84 [1.19-6.81], p = 0.019) were associated with poor outcomes. Post-procedural infarct volumes were significantly greater in hyperglycemic patients (padjusted = 0.003). Only overt hyperglycemia (9.28 [1.66-51.88], p = 0.011) was associated with parenchymal hematoma type 2. Overall hyperglycemia was associated with poor outcomes and infarct growth, whereas overt hyperglycemia was associated with parenchymal hematoma type 2.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Blood Glucose / analysis
  • Brain Infarction / etiology
  • Brain Infarction / pathology*
  • Brain Ischemia / physiopathology
  • Brain Ischemia / therapy*
  • Cerebral Hemorrhage / etiology
  • Cerebral Hemorrhage / pathology*
  • Diffusion Magnetic Resonance Imaging
  • Endovascular Procedures / adverse effects*
  • Female
  • Humans
  • Hyperglycemia / physiopathology*
  • Male
  • Reperfusion / adverse effects*
  • Stroke / physiopathology
  • Stroke / therapy*
  • Treatment Outcome

Substances

  • Blood Glucose