Association of baseline hyperglycemia with outcomes of patients with and without diabetes with acute ischemic stroke treated with intravenous thrombolysis

A propensity score-matched analysis from the SITS-ISTR registry

Georgios Tsivgoulis, Aristeidis H. Katsanos, Dimitris Mavridis, Vaia Lambadiari, Christine Roffe, Mary Joan MacLeod, Petr Sevcik, Manuel Cappellari, Miroslava Nevšímalová, Danilo Toni, Niaz Ahmed

Research output: Contribution to journalArticle

Abstract

Available data from observational studies on the association of admission hyperglycemia (aHG) with outcomes of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) are contradictory, especially when stratified by diabetes mellitus (DM) history. We assessed the association of aHG (≥144 mg/dL) with outcomes stratified by DM history using propensity score-matched (PSM) data from the SITS-ISTR. The primary safety outcome was symptomatic intracranial hemorrhage (SICH); 3-month functional independence (FI) (modified Rankin Scale [mRS] scores 0-2) represented the primary efficacy outcome. Patients with and without aHG did not differ in baseline characteristics both in the non-DM (n = 12,318) and DM (n = 6,572) PSM subgroups. In the non-DM group, patients with aHG had lower 3-month FI rates (53.3% vs. 57.9%, P < 0.001), higher 3-month mortality rates (19.2% vs. 16.0%, P < 0.001), and similar symptomatic intracerebral hemorrhage (SICH) rates (1.7% vs. 1.8%, P = 0.563) compared with patients without aHG. Similarly, in the DM group, patients with aHG had lower rates of 3-month favorable functional outcome (mRS scores 0-1, 34.1% vs. 39.3%, P < 0.001) and FI (48.2% vs. 52.5%, P < 0.001), higher 3-month mortality rates (23.7% vs. 19.9%, P < 0.001), and similar SICH rates (2.2% vs. 2.7%, P = 0.224) compared with patients without aHG. In conclusion, aHG was associated with unfavorable 3-month clinical outcomes in patients with and without DM and AIS treated with IVT.

Original languageEnglish (US)
Pages (from-to)1861-1869
Number of pages9
JournalDiabetes
Volume68
Issue number9
DOIs
StatePublished - Sep 1 2019

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4-Acetamido-4'-isothiocyanatostilbene-2,2'-disulfonic Acid
Propensity Score
Hyperglycemia
Registries
Stroke
Patient Admission
Diabetes Mellitus
Intracranial Hemorrhages
Mortality
Cerebral Hemorrhage
Observational Studies
Safety

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

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Association of baseline hyperglycemia with outcomes of patients with and without diabetes with acute ischemic stroke treated with intravenous thrombolysis : A propensity score-matched analysis from the SITS-ISTR registry. / Tsivgoulis, Georgios; Katsanos, Aristeidis H.; Mavridis, Dimitris; Lambadiari, Vaia; Roffe, Christine; MacLeod, Mary Joan; Sevcik, Petr; Cappellari, Manuel; Nevšímalová, Miroslava; Toni, Danilo; Ahmed, Niaz.

In: Diabetes, Vol. 68, No. 9, 01.09.2019, p. 1861-1869.

Research output: Contribution to journalArticle

Tsivgoulis, Georgios ; Katsanos, Aristeidis H. ; Mavridis, Dimitris ; Lambadiari, Vaia ; Roffe, Christine ; MacLeod, Mary Joan ; Sevcik, Petr ; Cappellari, Manuel ; Nevšímalová, Miroslava ; Toni, Danilo ; Ahmed, Niaz. / Association of baseline hyperglycemia with outcomes of patients with and without diabetes with acute ischemic stroke treated with intravenous thrombolysis : A propensity score-matched analysis from the SITS-ISTR registry. In: Diabetes. 2019 ; Vol. 68, No. 9. pp. 1861-1869.
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abstract = "Available data from observational studies on the association of admission hyperglycemia (aHG) with outcomes of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) are contradictory, especially when stratified by diabetes mellitus (DM) history. We assessed the association of aHG (≥144 mg/dL) with outcomes stratified by DM history using propensity score-matched (PSM) data from the SITS-ISTR. The primary safety outcome was symptomatic intracranial hemorrhage (SICH); 3-month functional independence (FI) (modified Rankin Scale [mRS] scores 0-2) represented the primary efficacy outcome. Patients with and without aHG did not differ in baseline characteristics both in the non-DM (n = 12,318) and DM (n = 6,572) PSM subgroups. In the non-DM group, patients with aHG had lower 3-month FI rates (53.3{\%} vs. 57.9{\%}, P < 0.001), higher 3-month mortality rates (19.2{\%} vs. 16.0{\%}, P < 0.001), and similar symptomatic intracerebral hemorrhage (SICH) rates (1.7{\%} vs. 1.8{\%}, P = 0.563) compared with patients without aHG. Similarly, in the DM group, patients with aHG had lower rates of 3-month favorable functional outcome (mRS scores 0-1, 34.1{\%} vs. 39.3{\%}, P < 0.001) and FI (48.2{\%} vs. 52.5{\%}, P < 0.001), higher 3-month mortality rates (23.7{\%} vs. 19.9{\%}, P < 0.001), and similar SICH rates (2.2{\%} vs. 2.7{\%}, P = 0.224) compared with patients without aHG. In conclusion, aHG was associated with unfavorable 3-month clinical outcomes in patients with and without DM and AIS treated with IVT.",
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T1 - Association of baseline hyperglycemia with outcomes of patients with and without diabetes with acute ischemic stroke treated with intravenous thrombolysis

T2 - A propensity score-matched analysis from the SITS-ISTR registry

AU - Tsivgoulis, Georgios

AU - Katsanos, Aristeidis H.

AU - Mavridis, Dimitris

AU - Lambadiari, Vaia

AU - Roffe, Christine

AU - MacLeod, Mary Joan

AU - Sevcik, Petr

AU - Cappellari, Manuel

AU - Nevšímalová, Miroslava

AU - Toni, Danilo

AU - Ahmed, Niaz

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N2 - Available data from observational studies on the association of admission hyperglycemia (aHG) with outcomes of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) are contradictory, especially when stratified by diabetes mellitus (DM) history. We assessed the association of aHG (≥144 mg/dL) with outcomes stratified by DM history using propensity score-matched (PSM) data from the SITS-ISTR. The primary safety outcome was symptomatic intracranial hemorrhage (SICH); 3-month functional independence (FI) (modified Rankin Scale [mRS] scores 0-2) represented the primary efficacy outcome. Patients with and without aHG did not differ in baseline characteristics both in the non-DM (n = 12,318) and DM (n = 6,572) PSM subgroups. In the non-DM group, patients with aHG had lower 3-month FI rates (53.3% vs. 57.9%, P < 0.001), higher 3-month mortality rates (19.2% vs. 16.0%, P < 0.001), and similar symptomatic intracerebral hemorrhage (SICH) rates (1.7% vs. 1.8%, P = 0.563) compared with patients without aHG. Similarly, in the DM group, patients with aHG had lower rates of 3-month favorable functional outcome (mRS scores 0-1, 34.1% vs. 39.3%, P < 0.001) and FI (48.2% vs. 52.5%, P < 0.001), higher 3-month mortality rates (23.7% vs. 19.9%, P < 0.001), and similar SICH rates (2.2% vs. 2.7%, P = 0.224) compared with patients without aHG. In conclusion, aHG was associated with unfavorable 3-month clinical outcomes in patients with and without DM and AIS treated with IVT.

AB - Available data from observational studies on the association of admission hyperglycemia (aHG) with outcomes of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) are contradictory, especially when stratified by diabetes mellitus (DM) history. We assessed the association of aHG (≥144 mg/dL) with outcomes stratified by DM history using propensity score-matched (PSM) data from the SITS-ISTR. The primary safety outcome was symptomatic intracranial hemorrhage (SICH); 3-month functional independence (FI) (modified Rankin Scale [mRS] scores 0-2) represented the primary efficacy outcome. Patients with and without aHG did not differ in baseline characteristics both in the non-DM (n = 12,318) and DM (n = 6,572) PSM subgroups. In the non-DM group, patients with aHG had lower 3-month FI rates (53.3% vs. 57.9%, P < 0.001), higher 3-month mortality rates (19.2% vs. 16.0%, P < 0.001), and similar symptomatic intracerebral hemorrhage (SICH) rates (1.7% vs. 1.8%, P = 0.563) compared with patients without aHG. Similarly, in the DM group, patients with aHG had lower rates of 3-month favorable functional outcome (mRS scores 0-1, 34.1% vs. 39.3%, P < 0.001) and FI (48.2% vs. 52.5%, P < 0.001), higher 3-month mortality rates (23.7% vs. 19.9%, P < 0.001), and similar SICH rates (2.2% vs. 2.7%, P = 0.224) compared with patients without aHG. In conclusion, aHG was associated with unfavorable 3-month clinical outcomes in patients with and without DM and AIS treated with IVT.

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