Admission hyperglycemia and outcomes in large vessel occlusion strokes treated with mechanical thrombectomy

Nitin Goyal, Georgios Tsivgoulis, Abhi Pandhi, Kira Dillard, Aristeidis H. Katsanos, Georgios Magoufis, Jason J. Chang, Ramin Zand, Daniel Hoit, Apostolos Safouris, Asim Choudhri, Anne Alexandrov, Andrei Alexandrov, Adam Arthur, Lucas Elijovich

Research output: Contribution to journalArticle

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Abstract

Background and purpose Higher admission serum glucose levels have been associated with poor outcomes in patients with acute ischemic stroke (AIS) treated with IV thrombolysis. We sought to evaluate the association of admission serum glucose with early outcomes of patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT). Methods Consecutive AIS patients due to ELVO treated with MT in three tertiary stroke centers were evaluated. The following outcomes were documented using standard definitions: symptomatic intracranial hemorrhage (sICH), complete reperfusion, mortality, functional independence (modified Rankin Scale (mRS) score of 0-2), and functional improvement (shift in mRS score) at 3 €months. The association of admission serum glucose and admission hyperglycemia (>140 €mg/dL) with outcomes was evaluated using univariable and multivariable binary and ordinal logistic regression models. Results 231 AIS patients with ELVO (mean age 62±14 €years, 51% men, median admission National Institute of Health Stroke Scale score 16 points (IQR 12-21), median admission serum glucose 125 €mg/dL (IQR 104-162)) were treated with MT. Admission hyperglycemia was associated with a lower likelihood of functional improvement (common OR 0.53; 95% CI 0.31 to 0.97; p=0.027) and higher odds of 3 month mortality (OR 2.76; 95% CI 1.40 to 5.44; p=0.004) in multivariable analyses adjusting for potential confounders. A 10 €mg/dL increase in admission blood glucose was associated with a higher likelihood of sICH (OR 1.07; 95% CI 1.01 to 1.13; p=0.033) and 3 month mortality (OR 1.07; 95% CI 1.02 to 1.12; p=0.004) in multivariable models. There was no association between admission serum glucose or hyperglycemia and complete reperfusion. Conclusions Higher admission serum glucose and admission hyperglycemia are independent predictors of adverse outcomes in ELVO patients treated with MT.

LanguageEnglish (US)
Pages112-117
Number of pages6
JournalJournal of NeuroInterventional Surgery
Volume10
Issue number2
DOIs
StatePublished - Feb 1 2018

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Thrombectomy
Hyperglycemia
Stroke
Glucose
Serum
Intracranial Hemorrhages
Reperfusion
Mortality
Logistic Models
National Institutes of Health (U.S.)
Blood Glucose

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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Admission hyperglycemia and outcomes in large vessel occlusion strokes treated with mechanical thrombectomy. / Goyal, Nitin; Tsivgoulis, Georgios; Pandhi, Abhi; Dillard, Kira; Katsanos, Aristeidis H.; Magoufis, Georgios; Chang, Jason J.; Zand, Ramin; Hoit, Daniel; Safouris, Apostolos; Choudhri, Asim; Alexandrov, Anne; Alexandrov, Andrei; Arthur, Adam; Elijovich, Lucas.

In: Journal of NeuroInterventional Surgery, Vol. 10, No. 2, 01.02.2018, p. 112-117.

Research output: Contribution to journalArticle

Goyal, Nitin ; Tsivgoulis, Georgios ; Pandhi, Abhi ; Dillard, Kira ; Katsanos, Aristeidis H. ; Magoufis, Georgios ; Chang, Jason J. ; Zand, Ramin ; Hoit, Daniel ; Safouris, Apostolos ; Choudhri, Asim ; Alexandrov, Anne ; Alexandrov, Andrei ; Arthur, Adam ; Elijovich, Lucas. / Admission hyperglycemia and outcomes in large vessel occlusion strokes treated with mechanical thrombectomy. In: Journal of NeuroInterventional Surgery. 2018 ; Vol. 10, No. 2. pp. 112-117.
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title = "Admission hyperglycemia and outcomes in large vessel occlusion strokes treated with mechanical thrombectomy",
abstract = "Background and purpose Higher admission serum glucose levels have been associated with poor outcomes in patients with acute ischemic stroke (AIS) treated with IV thrombolysis. We sought to evaluate the association of admission serum glucose with early outcomes of patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT). Methods Consecutive AIS patients due to ELVO treated with MT in three tertiary stroke centers were evaluated. The following outcomes were documented using standard definitions: symptomatic intracranial hemorrhage (sICH), complete reperfusion, mortality, functional independence (modified Rankin Scale (mRS) score of 0-2), and functional improvement (shift in mRS score) at 3 €months. The association of admission serum glucose and admission hyperglycemia (>140 €mg/dL) with outcomes was evaluated using univariable and multivariable binary and ordinal logistic regression models. Results 231 AIS patients with ELVO (mean age 62±14 €years, 51{\%} men, median admission National Institute of Health Stroke Scale score 16 points (IQR 12-21), median admission serum glucose 125 €mg/dL (IQR 104-162)) were treated with MT. Admission hyperglycemia was associated with a lower likelihood of functional improvement (common OR 0.53; 95{\%} CI 0.31 to 0.97; p=0.027) and higher odds of 3 month mortality (OR 2.76; 95{\%} CI 1.40 to 5.44; p=0.004) in multivariable analyses adjusting for potential confounders. A 10 €mg/dL increase in admission blood glucose was associated with a higher likelihood of sICH (OR 1.07; 95{\%} CI 1.01 to 1.13; p=0.033) and 3 month mortality (OR 1.07; 95{\%} CI 1.02 to 1.12; p=0.004) in multivariable models. There was no association between admission serum glucose or hyperglycemia and complete reperfusion. Conclusions Higher admission serum glucose and admission hyperglycemia are independent predictors of adverse outcomes in ELVO patients treated with MT.",
author = "Nitin Goyal and Georgios Tsivgoulis and Abhi Pandhi and Kira Dillard and Katsanos, {Aristeidis H.} and Georgios Magoufis and Chang, {Jason J.} and Ramin Zand and Daniel Hoit and Apostolos Safouris and Asim Choudhri and Anne Alexandrov and Andrei Alexandrov and Adam Arthur and Lucas Elijovich",
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T1 - Admission hyperglycemia and outcomes in large vessel occlusion strokes treated with mechanical thrombectomy

AU - Goyal, Nitin

AU - Tsivgoulis, Georgios

AU - Pandhi, Abhi

AU - Dillard, Kira

AU - Katsanos, Aristeidis H.

AU - Magoufis, Georgios

AU - Chang, Jason J.

AU - Zand, Ramin

AU - Hoit, Daniel

AU - Safouris, Apostolos

AU - Choudhri, Asim

AU - Alexandrov, Anne

AU - Alexandrov, Andrei

AU - Arthur, Adam

AU - Elijovich, Lucas

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Background and purpose Higher admission serum glucose levels have been associated with poor outcomes in patients with acute ischemic stroke (AIS) treated with IV thrombolysis. We sought to evaluate the association of admission serum glucose with early outcomes of patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT). Methods Consecutive AIS patients due to ELVO treated with MT in three tertiary stroke centers were evaluated. The following outcomes were documented using standard definitions: symptomatic intracranial hemorrhage (sICH), complete reperfusion, mortality, functional independence (modified Rankin Scale (mRS) score of 0-2), and functional improvement (shift in mRS score) at 3 €months. The association of admission serum glucose and admission hyperglycemia (>140 €mg/dL) with outcomes was evaluated using univariable and multivariable binary and ordinal logistic regression models. Results 231 AIS patients with ELVO (mean age 62±14 €years, 51% men, median admission National Institute of Health Stroke Scale score 16 points (IQR 12-21), median admission serum glucose 125 €mg/dL (IQR 104-162)) were treated with MT. Admission hyperglycemia was associated with a lower likelihood of functional improvement (common OR 0.53; 95% CI 0.31 to 0.97; p=0.027) and higher odds of 3 month mortality (OR 2.76; 95% CI 1.40 to 5.44; p=0.004) in multivariable analyses adjusting for potential confounders. A 10 €mg/dL increase in admission blood glucose was associated with a higher likelihood of sICH (OR 1.07; 95% CI 1.01 to 1.13; p=0.033) and 3 month mortality (OR 1.07; 95% CI 1.02 to 1.12; p=0.004) in multivariable models. There was no association between admission serum glucose or hyperglycemia and complete reperfusion. Conclusions Higher admission serum glucose and admission hyperglycemia are independent predictors of adverse outcomes in ELVO patients treated with MT.

AB - Background and purpose Higher admission serum glucose levels have been associated with poor outcomes in patients with acute ischemic stroke (AIS) treated with IV thrombolysis. We sought to evaluate the association of admission serum glucose with early outcomes of patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT). Methods Consecutive AIS patients due to ELVO treated with MT in three tertiary stroke centers were evaluated. The following outcomes were documented using standard definitions: symptomatic intracranial hemorrhage (sICH), complete reperfusion, mortality, functional independence (modified Rankin Scale (mRS) score of 0-2), and functional improvement (shift in mRS score) at 3 €months. The association of admission serum glucose and admission hyperglycemia (>140 €mg/dL) with outcomes was evaluated using univariable and multivariable binary and ordinal logistic regression models. Results 231 AIS patients with ELVO (mean age 62±14 €years, 51% men, median admission National Institute of Health Stroke Scale score 16 points (IQR 12-21), median admission serum glucose 125 €mg/dL (IQR 104-162)) were treated with MT. Admission hyperglycemia was associated with a lower likelihood of functional improvement (common OR 0.53; 95% CI 0.31 to 0.97; p=0.027) and higher odds of 3 month mortality (OR 2.76; 95% CI 1.40 to 5.44; p=0.004) in multivariable analyses adjusting for potential confounders. A 10 €mg/dL increase in admission blood glucose was associated with a higher likelihood of sICH (OR 1.07; 95% CI 1.01 to 1.13; p=0.033) and 3 month mortality (OR 1.07; 95% CI 1.02 to 1.12; p=0.004) in multivariable models. There was no association between admission serum glucose or hyperglycemia and complete reperfusion. Conclusions Higher admission serum glucose and admission hyperglycemia are independent predictors of adverse outcomes in ELVO patients treated with MT.

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