Hyperglycemia May Worsen Outcomes of Intravenous Thrombolysis in Patients With Acute Ischemic Stroke

Hyperglycemia on admission is associated with worse clinical outcomes in patients with and without diabetes mellitus (DM) following intravenous thrombolysis (IVT) for acute ischemic stroke (AIS), according to study results published in Diabetes.

Previous studies have reported that hyperglycemia after AIS is an independent predictor of poor outcome, including in patients treated with IVT. However, as there were discrepant findings when stratified by history of DM, the goal of the study was to explore the association of admission hyperglycemia (≥144 mg/dl) with outcome following IVT in patients with AIS stratified by the history of DM.

The primary safety outcome was the difference in symptomatic intracerebral hemorrhage rates between patients with and without admission hyperglycemia, using propensity score-matched data from the Safe Implementation of Treatments in Stroke International Stroke (SITS) Thrombolysis International Register. The primary efficacy outcome was the difference in functional independence rates at three months according to modified Rankin Scale of 0 to 2.

Of 109,324 consecutive patients with AIS treated with IVT between January 2010 and December 2017, the study cohort included 12,318 patients without diabetes and 6572 patients with diabetes and admission hyperglycemia.

In patients without diabetes, admission hyperglycemia was associated with lower rates of favorable functional outcome (40.6% vs. 44.2%, P <.001) functional independence (53.3% vs. 57.9%, P <.001), and higher mortality risk (19.2% vs. 16.0%, P <.001) after three months, compared with patients without admission hyperglycemia.

In a similar fashion, in patients with DM, admission hyperglycemia was associated with lower rates of favorable functional outcome (34.1% vs 39.3%, P <.001), functional independence (48.2% vs. 52.5%, P <.001), and higher mortality rates (23.7% vs. 19.9%, P <.001) after three months compared with patients without admission hyperglycemia.

There was no association between admission w and the risk for symptomatic intracerebral hemorrhage in patients with or without DM.

The researchers acknowledged several study limitations, including possible selection and reporting biases, lack of information regarding glycated hemoglobin or antidiabetic treatment duration and the cause of death.  

“Future randomized-controlled clinical trials on the potential utility of moderate [glycemic] control in the population of AIS patients treated with IVT that present with [hyperglycemia] before tPA-bolus appear to be warranted”, the investigators concluded.

Reference
Tsivgoulis G, Katsanos AH, Mavridis D, et al. Association of baseline hyperglycaemia with outcomes of diabetic and non-diabetic acute ischaemic stroke patients treated with intravenous thrombolysis: A propensity score matched analysis from the SITS-ISTR registry [published online June 2019]. Diabetes. doi:10.2337/db19-0440