The impact of postadmission glycemia on stroke outcome: Glucose normalisation is associated with better survival

Abstract

Background: Hyperglycemia on admission increases the risk of death in patients with acute stroke. It remains unclear whether glucose normalisation after admission is associated with improved survival. The goal of the study was to determine the relationship between postadmission glucose levels and mortality in stroke patients with and without admission hyperglycemia.

Methods: 302 patients with first-ever ischemic stroke and without prior diagnosis of diabetes mellitus were enrolled. Random plasma glucose level was measured on admission and fasting glucose on day 1, 2, 3, 5 and 7. Hyperglycemia on admission was defined as glucose level > or = 7.8 mmol/L. Postadmission hyperglycemia was diagnosed if mean postadmission fasting glucose level was > or = 6.1 mmol/L.

Results: After multivariable adjustment, postadmission hyperglycemia was associated with higher risk of death regardless of admission glucose levels (HR: 1.80, 95%CI: 1.39-2.86, P<0.01). Postadmission hyperglycemia increases risk of death in both patients with admission hyperglycemia (HR: 4.83, 95%CI: 1.93-12.06, P<0.01) and those with admission normoglycemia (HR: 1.64, 95%CI: 1.06-2.54, P=0.03). In patients with admission hyperglycemia glucose normalisation after admission was associated with reduced risk of death compared to those with persistent hyperglycemia (HR: 0.21, 95%CI: 0.08-0.52). The patients who were normoglycemic on day 1 and developed hyperglycemia on next days had increased risk of death compared to persistent normoglycemic patients (HR: 1.55, 95%CI: 1.01-2.39, P=0.04).

Conclusions: Postadmission, but not admission, hyperglycemia is associated with increased risk of death. Glucose normalisation after admission is associated with better survival.