Diabetes mellitus, admission glucose, and outcomes after stroke thrombolysis: a registry and systematic review.
Stroke
; 44(7): 1915-23, 2013 Jul.
Article
in En
| MEDLINE
| ID: mdl-23704108
ABSTRACT
BACKGROUND AND PURPOSE:
The potential detrimental effect of diabetes mellitus and admission glucose level (AGL) on outcomes after stroke thrombolysis is unclear. We evaluated outcomes of patients treated by intravenous and/or intra-arterial therapy, according to diabetes mellitus and AGL.METHODS:
We analyzed data from a patient registry (n=704) and conducted a systematic review of previous observational studies. The primary study outcome was the percentage of patients who achieved a favorable outcome (modified Rankin score ≤2 at 3 months).RESULTS:
We identified 54 previous reports that evaluated the effect of diabetes mellitus or AGL on outcomes after thrombolysis. In an unadjusted meta-analysis that included our registry data and previous available observational data, diabetes mellitus was associated with less favorable outcome (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.73-0.79) and more symptomatic intracranial hemorrhage (OR, 1.38; 95% CI, 1.21-1.56). However, in multivariable analysis, diabetes mellitus remained associated with less favorable outcome (OR, 0.77; 95% CI, 0.69-0.87) but not with symptomatic intracranial hemorrhage (OR, 1.11; 95% CI, 0.83-1.48). In unadjusted and in adjusted meta-analysis, higher AGL was associated with less favorable outcome and more symptomatic intracranial hemorrhage; the adjusted OR (95% CI) per 1 mmol/L increase in AGL was 0.92 (0.90-0.94) for favorable outcome, and 1.09 (1.04-1.14) for symptomatic intracranial hemorrhage.CONCLUSIONS:
These results confirm that AGL and history of diabetes mellitus are associated with poor clinical outcome after thrombolysis. AGL may be a surrogate marker of brain infarction severity rather than a causal factor. However, randomized controlled evidences are needed to address the significance of a tight glucose control during thrombolysis on clinical outcome.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Patient Admission
/
Blood Glucose
/
Thrombolytic Therapy
/
Registries
/
Treatment Outcome
/
Stroke
/
Diabetes Mellitus
Type of study:
Clinical_trials
/
Observational_studies
/
Prognostic_studies
/
Systematic_reviews
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Stroke
Year:
2013
Document type:
Article
Affiliation country:
France