Admission glucose level and clinical outcomes in the NINDS rt-PA stroke trial

Askiel Bruno, S. R. Levine, M. R. Frankel, T. G. Brott, Y. Lin, B. C. Tilley, P. D. Lyden, J. P. Broderick, T. G. Kwiatkowski, S. E. Fineberg

Research output: Contribution to journalArticle

383 Citations (Scopus)

Abstract

Background: Hyperglycemia during acute ischemic stroke may augment brain injury, predispose to intracerebral hemorrhage (ICH), or both. Method: To analyze the relationship between admission glucose level and clinical outcomes from acute ischemic stroke, the authors performed multivariate regression analysis with the National Institute of Neurological Disorders and Stroke recombinant tissue plasminogen activator (rt-PA) Stroke Trial data. Neurologic improvement was defined as improvement on the NIH Stroke Scale by 4 or more points from baseline to 3 months, or a final score of zero. Favorable outcome was defined as both Glasgow Outcome score of 1 and Barthel Index 95 to 100 at 3 months. Symptomatic ICH was defined as CT-documented hemorrhage temporally related to clinical deterioration within 36 hours of treatment. Potential confounding factors were controlled, including acute treatment (rt-PA or placebo), age, baseline NIH Stroke Scale score, history of diabetes mellitus, stroke subtype, and admission blood pressure. Results: There were 624 patients enrolled within 3 hours after stroke onset. As admission glucose increased, the odds for neurologic improvement decreased (odds ratio [OR] = 0.76 per 100 mg/dL increase in admission glucose, 95% CI 0.61 to 0.95, p = 0.01). The relation between admission glucose and favorable outcome depended on admission mean blood pressure (MBP): as admission MBP increased, the odds for favorable outcome related to increasing admission glucose levels progressively decreased (p = 0.02). As admission glucose increased, the odds for symptomatic ICH also increased (OR = 1.75 per 100 mg/dL increase in admission glucose, 95% CI 1.11 to 2.78, p = 0.02). Admission glucose level was not associated with altered effectiveness of rt-PA. Conclusions: In patients with acute ischemic stroke, higher admission glucose levels are associated with significantly lower odds for desirable clinical outcomes and significantly higher odds for symptomatic ICH, regardless of rt-PA treatment. Whether this represents a cause and effect relationship remains to be determined.

Original languageEnglish (US)
Pages (from-to)669-674
Number of pages6
JournalNeurology
Volume59
Issue number5
DOIs
StatePublished - Sep 10 2002

Fingerprint

National Institute of Neurological Disorders and Stroke
Tissue Plasminogen Activator
Stroke
Glucose
Cerebral Hemorrhage
Blood Pressure
Nervous System
Odds Ratio
Hyperglycemia
Brain Injuries
Diabetes Mellitus
Therapeutics
Multivariate Analysis
Placebos
Regression Analysis
Hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Bruno, A., Levine, S. R., Frankel, M. R., Brott, T. G., Lin, Y., Tilley, B. C., ... Fineberg, S. E. (2002). Admission glucose level and clinical outcomes in the NINDS rt-PA stroke trial. Neurology, 59(5), 669-674. https://doi.org/10.1212/WNL.59.5.669

Admission glucose level and clinical outcomes in the NINDS rt-PA stroke trial. / Bruno, Askiel; Levine, S. R.; Frankel, M. R.; Brott, T. G.; Lin, Y.; Tilley, B. C.; Lyden, P. D.; Broderick, J. P.; Kwiatkowski, T. G.; Fineberg, S. E.

In: Neurology, Vol. 59, No. 5, 10.09.2002, p. 669-674.

Research output: Contribution to journalArticle

Bruno, A, Levine, SR, Frankel, MR, Brott, TG, Lin, Y, Tilley, BC, Lyden, PD, Broderick, JP, Kwiatkowski, TG & Fineberg, SE 2002, 'Admission glucose level and clinical outcomes in the NINDS rt-PA stroke trial', Neurology, vol. 59, no. 5, pp. 669-674. https://doi.org/10.1212/WNL.59.5.669
Bruno A, Levine SR, Frankel MR, Brott TG, Lin Y, Tilley BC et al. Admission glucose level and clinical outcomes in the NINDS rt-PA stroke trial. Neurology. 2002 Sep 10;59(5):669-674. https://doi.org/10.1212/WNL.59.5.669
Bruno, Askiel ; Levine, S. R. ; Frankel, M. R. ; Brott, T. G. ; Lin, Y. ; Tilley, B. C. ; Lyden, P. D. ; Broderick, J. P. ; Kwiatkowski, T. G. ; Fineberg, S. E. / Admission glucose level and clinical outcomes in the NINDS rt-PA stroke trial. In: Neurology. 2002 ; Vol. 59, No. 5. pp. 669-674.
@article{d0b8c1d870474d4c8893a3b2aebe1051,
title = "Admission glucose level and clinical outcomes in the NINDS rt-PA stroke trial",
abstract = "Background: Hyperglycemia during acute ischemic stroke may augment brain injury, predispose to intracerebral hemorrhage (ICH), or both. Method: To analyze the relationship between admission glucose level and clinical outcomes from acute ischemic stroke, the authors performed multivariate regression analysis with the National Institute of Neurological Disorders and Stroke recombinant tissue plasminogen activator (rt-PA) Stroke Trial data. Neurologic improvement was defined as improvement on the NIH Stroke Scale by 4 or more points from baseline to 3 months, or a final score of zero. Favorable outcome was defined as both Glasgow Outcome score of 1 and Barthel Index 95 to 100 at 3 months. Symptomatic ICH was defined as CT-documented hemorrhage temporally related to clinical deterioration within 36 hours of treatment. Potential confounding factors were controlled, including acute treatment (rt-PA or placebo), age, baseline NIH Stroke Scale score, history of diabetes mellitus, stroke subtype, and admission blood pressure. Results: There were 624 patients enrolled within 3 hours after stroke onset. As admission glucose increased, the odds for neurologic improvement decreased (odds ratio [OR] = 0.76 per 100 mg/dL increase in admission glucose, 95{\%} CI 0.61 to 0.95, p = 0.01). The relation between admission glucose and favorable outcome depended on admission mean blood pressure (MBP): as admission MBP increased, the odds for favorable outcome related to increasing admission glucose levels progressively decreased (p = 0.02). As admission glucose increased, the odds for symptomatic ICH also increased (OR = 1.75 per 100 mg/dL increase in admission glucose, 95{\%} CI 1.11 to 2.78, p = 0.02). Admission glucose level was not associated with altered effectiveness of rt-PA. Conclusions: In patients with acute ischemic stroke, higher admission glucose levels are associated with significantly lower odds for desirable clinical outcomes and significantly higher odds for symptomatic ICH, regardless of rt-PA treatment. Whether this represents a cause and effect relationship remains to be determined.",
author = "Askiel Bruno and Levine, {S. R.} and Frankel, {M. R.} and Brott, {T. G.} and Y. Lin and Tilley, {B. C.} and Lyden, {P. D.} and Broderick, {J. P.} and Kwiatkowski, {T. G.} and Fineberg, {S. E.}",
year = "2002",
month = "9",
day = "10",
doi = "10.1212/WNL.59.5.669",
language = "English (US)",
volume = "59",
pages = "669--674",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Admission glucose level and clinical outcomes in the NINDS rt-PA stroke trial

AU - Bruno, Askiel

AU - Levine, S. R.

AU - Frankel, M. R.

AU - Brott, T. G.

AU - Lin, Y.

AU - Tilley, B. C.

AU - Lyden, P. D.

AU - Broderick, J. P.

AU - Kwiatkowski, T. G.

AU - Fineberg, S. E.

PY - 2002/9/10

Y1 - 2002/9/10

N2 - Background: Hyperglycemia during acute ischemic stroke may augment brain injury, predispose to intracerebral hemorrhage (ICH), or both. Method: To analyze the relationship between admission glucose level and clinical outcomes from acute ischemic stroke, the authors performed multivariate regression analysis with the National Institute of Neurological Disorders and Stroke recombinant tissue plasminogen activator (rt-PA) Stroke Trial data. Neurologic improvement was defined as improvement on the NIH Stroke Scale by 4 or more points from baseline to 3 months, or a final score of zero. Favorable outcome was defined as both Glasgow Outcome score of 1 and Barthel Index 95 to 100 at 3 months. Symptomatic ICH was defined as CT-documented hemorrhage temporally related to clinical deterioration within 36 hours of treatment. Potential confounding factors were controlled, including acute treatment (rt-PA or placebo), age, baseline NIH Stroke Scale score, history of diabetes mellitus, stroke subtype, and admission blood pressure. Results: There were 624 patients enrolled within 3 hours after stroke onset. As admission glucose increased, the odds for neurologic improvement decreased (odds ratio [OR] = 0.76 per 100 mg/dL increase in admission glucose, 95% CI 0.61 to 0.95, p = 0.01). The relation between admission glucose and favorable outcome depended on admission mean blood pressure (MBP): as admission MBP increased, the odds for favorable outcome related to increasing admission glucose levels progressively decreased (p = 0.02). As admission glucose increased, the odds for symptomatic ICH also increased (OR = 1.75 per 100 mg/dL increase in admission glucose, 95% CI 1.11 to 2.78, p = 0.02). Admission glucose level was not associated with altered effectiveness of rt-PA. Conclusions: In patients with acute ischemic stroke, higher admission glucose levels are associated with significantly lower odds for desirable clinical outcomes and significantly higher odds for symptomatic ICH, regardless of rt-PA treatment. Whether this represents a cause and effect relationship remains to be determined.

AB - Background: Hyperglycemia during acute ischemic stroke may augment brain injury, predispose to intracerebral hemorrhage (ICH), or both. Method: To analyze the relationship between admission glucose level and clinical outcomes from acute ischemic stroke, the authors performed multivariate regression analysis with the National Institute of Neurological Disorders and Stroke recombinant tissue plasminogen activator (rt-PA) Stroke Trial data. Neurologic improvement was defined as improvement on the NIH Stroke Scale by 4 or more points from baseline to 3 months, or a final score of zero. Favorable outcome was defined as both Glasgow Outcome score of 1 and Barthel Index 95 to 100 at 3 months. Symptomatic ICH was defined as CT-documented hemorrhage temporally related to clinical deterioration within 36 hours of treatment. Potential confounding factors were controlled, including acute treatment (rt-PA or placebo), age, baseline NIH Stroke Scale score, history of diabetes mellitus, stroke subtype, and admission blood pressure. Results: There were 624 patients enrolled within 3 hours after stroke onset. As admission glucose increased, the odds for neurologic improvement decreased (odds ratio [OR] = 0.76 per 100 mg/dL increase in admission glucose, 95% CI 0.61 to 0.95, p = 0.01). The relation between admission glucose and favorable outcome depended on admission mean blood pressure (MBP): as admission MBP increased, the odds for favorable outcome related to increasing admission glucose levels progressively decreased (p = 0.02). As admission glucose increased, the odds for symptomatic ICH also increased (OR = 1.75 per 100 mg/dL increase in admission glucose, 95% CI 1.11 to 2.78, p = 0.02). Admission glucose level was not associated with altered effectiveness of rt-PA. Conclusions: In patients with acute ischemic stroke, higher admission glucose levels are associated with significantly lower odds for desirable clinical outcomes and significantly higher odds for symptomatic ICH, regardless of rt-PA treatment. Whether this represents a cause and effect relationship remains to be determined.

UR - http://www.scopus.com/inward/record.url?scp=0037056360&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037056360&partnerID=8YFLogxK

U2 - 10.1212/WNL.59.5.669

DO - 10.1212/WNL.59.5.669

M3 - Article

C2 - 12221155

AN - SCOPUS:0037056360

VL - 59

SP - 669

EP - 674

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 5

ER -