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Moderate hyperglycaemia is associated with favourable outcome in acute lacunar stroke

Uyttenboogaart, M., Koch, M. W., Stewart, R. E., Vroomen, P. C., Luijckx, G-J. & De Keyser, J., Jun-2007, In : Brain. 130, Pt 6, p. 1626-1630 5 p.

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Hyperglycaemia in acute ischaemic stroke is traditionally associated with a worsened outcome. However, it is unclear whether the impact of hyperglycaemia on stroke outcome is similar in lacunar and non-lacunar infarctions.

The relation between serum glucose measured within 6 h after stroke onset and functional outcome was investigated in 1375 ischaemic stroke patients who had been included in two placebo-controlled trials with lubeluzole. The endpoint was a favourable outcome, defined as a modified Rankin Scale score <2 at 3 months. Classification into lacunar (n = 168) and non-lacunar (n = 1207) strokes was based on clinical criteria according to the Oxfordshire Community Stroke Project and findings on brain CT scan. Hyperglycaernia was defined as blood glucose > 8 mmol/l. A possible concentration-dependent effect of glucose on outcome was investigated in both lacunar and non-lacunar stroke.

Multivariate analysis showed that hyperglycaernia was associated with decreased odds of a favourable outcome in non-lacunar stroke (OR 0.60; 95% CI 0.41-0.88, P = 0.009), but with increased odds of a favourable outcome in lacunar stroke (multivariate OR for glucose >8 mmol/l: 2.70; 95% CI 1.01-713, P = 0.048). In non-lacunar stroke, there appeared to be a concentration-effect relation, as the odds of favourable outcome gradually decreased with increasing glucose levels. In lacunar stroke, an association with favourable outcome was observed with glucose levels >8 mmol/l, but this beneficial effect diminished with more severe hyperglycaernia > 12 mmol/l.

In conclusion, hyperglycaernia has a detrimental effect in non-lacunar stroke, but moderate hyperglycaernia may be beneficial in lacunar stroke.

Original languageEnglish
Pages (from-to)1626-1630
Number of pages5
JournalBrain
Volume130
Issue numberPt 6
Publication statusPublished - Jun-2007

    Keywords

  • ischaemic stroke, hyperglycaemia, lacunar stroke, stroke subtype, ACUTE ISCHEMIC-STROKE, ADMISSION HYPERGLYCEMIA, CEREBRAL INFARCTION, FOREBRAIN ISCHEMIA, GLUCOSE LEVEL, LUBELUZOLE, MORBIDITY, MORTALITY, SUBTYPES, INSULIN

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