Serum glucose level and diabetes predict tissue plasminogen activator-related intracerebral hemorrhage in acute ischemic stroke

被引:312
作者
Demchuk, AM
Morgenstern, LB
Krieger, DW
Chi, TL
Hu, W
Wein, TH
Hardy, RJ
Grotta, JC
Buchan, AM
机构
[1] Univ Texas, Dept Neurol, Stroke Program, Houston, TX 77030 USA
[2] Univ Texas, Sch Publ Hlth, Coordinating Ctr Clin Trials, Houston, TX 77030 USA
[3] Univ Calgary, Dept Clin Neurosci, Calgary, AB T2N 1N4, Canada
关键词
cerebral hemorrhage; diabetes mellitus; glucose; stroke; acute; thrombolytic therapy;
D O I
10.1161/01.STR.30.1.34
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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.
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页码:34 / 39
页数:6
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