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Ngiam JN, Cheong CWS, Leow AST, et al. Stress Hyperglycaemia is Associated with Poor Functional Outcomes in Patients with Acute Ischaemic Stroke after Intravenous Thrombolysis. QJM. 2020;doi: 10.1093/qjmed/hcaa253.
Ngiam, J. N., Cheong, C. W. S., Leow, A. S. T., Wei, Y. T., Thet, J. K. X., Lee, I. Y. S., Sia, C. H., Tan, B. Y. Q., Khoo, C. M., Sharma, V. K., & Yeo, L. L. L. (2020). Stress Hyperglycaemia is Associated with Poor Functional Outcomes in Patients with Acute Ischaemic Stroke after Intravenous Thrombolysis. QJM : monthly journal of the Association of Physicians, . https://doi.org/10.1093/qjmed/hcaa253
Ngiam, Jinghao Nicholas, et al. "Stress Hyperglycaemia is Associated with Poor Functional Outcomes in Patients with Acute Ischaemic Stroke after Intravenous Thrombolysis." QJM : monthly journal of the Association of Physicians vol. (2020). doi: https://doi.org/10.1093/qjmed/hcaa253
Ngiam JN, Cheong CWS, Leow AST, Wei YT, Thet JKX, Lee IYS, Sia CH, Tan BYQ, Khoo CM, Sharma VK, Yeo LLL. Stress Hyperglycaemia is Associated with Poor Functional Outcomes in Patients with Acute Ischaemic Stroke after Intravenous Thrombolysis. QJM. 2020 Aug 18; doi: 10.1093/qjmed/hcaa253. Epub 2020 Aug 18. PMID: 32810234.
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QJM. 2020 Aug 18; doi: 10.1093/qjmed/hcaa253. Epub 2020 Aug 18.

Stress Hyperglycaemia is Associated with Poor Functional Outcomes in Patients with Acute Ischaemic Stroke after Intravenous Thrombolysis.

QJM : monthly journal of the Association of Physicians

Jinghao Nicholas Ngiam, Clarissa W S Cheong, Aloysius S T Leow, Yuen-Tin Wei, Jordan K X Thet, Isabel Y S Lee, Ching-Hui Sia, Benjamin Y Q Tan, Chin-Meng Khoo, Vijay K Sharma, Leonard L L Yeo

Affiliations

  1. Division of Neurology, Department of Medicine, National University Health System, Singapore.
  2. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
  3. Department of Cardiology, National University Heart Centre Singapore, Singapore.
  4. Division of Endocrinology, Department of Medicine, National University Health System, Singapore.

PMID: 32810234 DOI: 10.1093/qjmed/hcaa253

Abstract

BACKGROUND: Transient hyperglycaemia in the context of illness with or without known diabetes has been termed as 'stress hyperglycaemia'. Stress hyperglycaemia can result in poor functional outcomes in patients with acute ischaemic stroke who underwent mechanical thrombectomy. We investigated the association between stress hyperglycaemia and clinical outcomes in acute ischaemic stroke patients undergoing intravenous thrombolysis (IVT).

METHODS: We examined 666 consecutive patients with acute ischaemic stroke who underwent IVT from 2006-2018. All patients had a glycated haemoglobin level (HbA1c) and fasting venous blood glucose measured within 24 hours of admission. Stress hyperglycaemia ratio (SHR) was defined as the ratio of the fasting glucose to the HbA1c. Univariate and multivariate analyses were employed to identify predictors of poor functional outcomes (modified Rankin Scale 3-6 at 3 months) after IVT.

RESULTS: Three-hundred and sixty-one patients (54.2%) had good functional outcomes. These patients tended to be younger (60.7±12.7 vs 70 ±14.4 years, p < 0.001), male (70.7% vs 51.5%, p < 0.001), had lower prevalence of atrial fibrillation (13.0% vs 20.7%, p = 0.008) and lower SHR (0.88±0.20 vs 0.99±26, p < 0.001). Patients with high SHR (≥0.97) were slightly older than those with low SHR (<0.97), and were more likely to have diabetes mellitus. On multivariate analysis, higher SHR was independently associated with poor functional outcomes (adjusted odds ratio 3.85, 95% CI 1.59 - 9.09, p = 0.003).

CONCLUSIONS: SHR appears to be an important predictor of functional outcomes in patients with AIS undergoing IVT. This may have important implications on the role of glycaemic control in the acute management of ischaemic stroke.

© The Author(s) 2020. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected].

Keywords: HbA1c; acute ischaemic stroke; intravenous thrombolysis; stress hyperglycaemia; stress hyperglycaemia ratio

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