Higher blood glucose is associated with the severity of hemorrhagic transformation after endovascular therapy for stroke
•Large vessel occlusion stroke may be particularly vulnerable to the effects of hyperglycemia.•We analyzed intracerebral hemorrhage severity as a result of hyperglycemia-induced toxicity.•Increasing blood glucose was associated with increasing severity of intracerebral hemorrhage.•Future study is ne...
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Veröffentlicht in: | Journal of stroke and cerebrovascular diseases 2024-08, Vol.33 (8), p.107823, Article 107823 |
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creator | Aziz, Yasmin N Vagal, Vaibhav Mehta, Tapan Vijaykumar Siegler, James E Mistry, Akshitkumar M Yaghi, Shadi Khatri, Pooja Mistry, Eva A |
description | •Large vessel occlusion stroke may be particularly vulnerable to the effects of hyperglycemia.•We analyzed intracerebral hemorrhage severity as a result of hyperglycemia-induced toxicity.•Increasing blood glucose was associated with increasing severity of intracerebral hemorrhage.•Future study is needed to determine if glycemic control improves outcomes in this population.
Hyperglycemia is associated with poor outcome in large vessel occlusion (LVO) stroke, with mechanism for this effect unknown.
We used our prospective, multicenter, observational study, Blood Pressure After Endovascular Stroke Therapy (BEST), of anterior circulation LVO stroke undergoing endovascular therapy (EVT) from 11/2017-7/2018 to determine association between increasing blood glucose (BG) and intracerebral hemorrhage (ICH). Our primary outcome was degree of ICH, classified as none, asymptomatic ICH, or symptomatic ICH (≥4-point increase in National Institutes of Health Stroke Scale [NIHSS] at 24 h with any hemorrhage on imaging). Secondary outcomes included 24 h NIHSS, early neurologic recovery (ENR, NIHSS 0-1 or NIHSS reduction by ≥8 within 24 h), and 90-day modified Rankin Scale (mRS) using univariate and multivariable regression.
Of 485 enrolled patients, increasing BG was associated with increasing severity of ICH (adjusted OR, aOR 1.06, 95 % CI 1.02-1.1, p < 0.001), higher 24 h NIHSS (aOR 1.22, 95 % CI 1.11-1.34, p < 0.001), ENR (aOR 0.90, 95 % CI 0.82-1.00, p < 0.002), and 90-day mRS (aOR 1.06, 95 % CI 1.03-1.09, p < 0.001) when adjusted for age, presenting NIHSS, ASPECTS, 24-hour peak systolic blood pressure, time from last known well, and successful recanalization.
In the BEST study, increasing BG was associated with greater odds of increasing ICH severity. Further study is warranted to determine whether treatment of will decrease ICH severity following EVT. |
doi_str_mv | 10.1016/j.jstrokecerebrovasdis.2024.107823 |
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Hyperglycemia is associated with poor outcome in large vessel occlusion (LVO) stroke, with mechanism for this effect unknown.
We used our prospective, multicenter, observational study, Blood Pressure After Endovascular Stroke Therapy (BEST), of anterior circulation LVO stroke undergoing endovascular therapy (EVT) from 11/2017-7/2018 to determine association between increasing blood glucose (BG) and intracerebral hemorrhage (ICH). Our primary outcome was degree of ICH, classified as none, asymptomatic ICH, or symptomatic ICH (≥4-point increase in National Institutes of Health Stroke Scale [NIHSS] at 24 h with any hemorrhage on imaging). Secondary outcomes included 24 h NIHSS, early neurologic recovery (ENR, NIHSS 0-1 or NIHSS reduction by ≥8 within 24 h), and 90-day modified Rankin Scale (mRS) using univariate and multivariable regression.
Of 485 enrolled patients, increasing BG was associated with increasing severity of ICH (adjusted OR, aOR 1.06, 95 % CI 1.02-1.1, p < 0.001), higher 24 h NIHSS (aOR 1.22, 95 % CI 1.11-1.34, p < 0.001), ENR (aOR 0.90, 95 % CI 0.82-1.00, p < 0.002), and 90-day mRS (aOR 1.06, 95 % CI 1.03-1.09, p < 0.001) when adjusted for age, presenting NIHSS, ASPECTS, 24-hour peak systolic blood pressure, time from last known well, and successful recanalization.
In the BEST study, increasing BG was associated with greater odds of increasing ICH severity. Further study is warranted to determine whether treatment of will decrease ICH severity following EVT.</description><identifier>ISSN: 1052-3057</identifier><identifier>ISSN: 1532-8511</identifier><identifier>EISSN: 1532-8511</identifier><identifier>DOI: 10.1016/j.jstrokecerebrovasdis.2024.107823</identifier><identifier>PMID: 38880367</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Biomarkers - blood ; Blood Glucose - metabolism ; Cerebral Hemorrhage - blood ; Cerebral Hemorrhage - diagnosis ; Cerebral Hemorrhage - diagnostic imaging ; Cerebral Hemorrhage - etiology ; Cerebral Hemorrhage - therapy ; Disability Evaluation ; Endovascular Procedures - adverse effects ; Endovascular therapy ; Female ; Humans ; Hyperglycemia ; Hyperglycemia - blood ; Hyperglycemia - complications ; Hyperglycemia - diagnosis ; Hyperglycemia - therapy ; Intracerebral hemorrhage ; Male ; Middle Aged ; Prospective Studies ; Recovery of Function ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Stroke ; Stroke - blood ; Stroke - diagnosis ; Stroke - physiopathology ; Stroke - therapy ; Time Factors ; Treatment Outcome ; United States</subject><ispartof>Journal of stroke and cerebrovascular diseases, 2024-08, Vol.33 (8), p.107823, Article 107823</ispartof><rights>2024</rights><rights>Copyright © 2024. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c269t-985cb21f9bcb0ccd89ab9746de7bd61701067b2539f9f80b837728162e0484c53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2024.107823$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38880367$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Aziz, Yasmin N</creatorcontrib><creatorcontrib>Vagal, Vaibhav</creatorcontrib><creatorcontrib>Mehta, Tapan Vijaykumar</creatorcontrib><creatorcontrib>Siegler, James E</creatorcontrib><creatorcontrib>Mistry, Akshitkumar M</creatorcontrib><creatorcontrib>Yaghi, Shadi</creatorcontrib><creatorcontrib>Khatri, Pooja</creatorcontrib><creatorcontrib>Mistry, Eva A</creatorcontrib><title>Higher blood glucose is associated with the severity of hemorrhagic transformation after endovascular therapy for stroke</title><title>Journal of stroke and cerebrovascular diseases</title><addtitle>J Stroke Cerebrovasc Dis</addtitle><description>•Large vessel occlusion stroke may be particularly vulnerable to the effects of hyperglycemia.•We analyzed intracerebral hemorrhage severity as a result of hyperglycemia-induced toxicity.•Increasing blood glucose was associated with increasing severity of intracerebral hemorrhage.•Future study is needed to determine if glycemic control improves outcomes in this population.
Hyperglycemia is associated with poor outcome in large vessel occlusion (LVO) stroke, with mechanism for this effect unknown.
We used our prospective, multicenter, observational study, Blood Pressure After Endovascular Stroke Therapy (BEST), of anterior circulation LVO stroke undergoing endovascular therapy (EVT) from 11/2017-7/2018 to determine association between increasing blood glucose (BG) and intracerebral hemorrhage (ICH). Our primary outcome was degree of ICH, classified as none, asymptomatic ICH, or symptomatic ICH (≥4-point increase in National Institutes of Health Stroke Scale [NIHSS] at 24 h with any hemorrhage on imaging). Secondary outcomes included 24 h NIHSS, early neurologic recovery (ENR, NIHSS 0-1 or NIHSS reduction by ≥8 within 24 h), and 90-day modified Rankin Scale (mRS) using univariate and multivariable regression.
Of 485 enrolled patients, increasing BG was associated with increasing severity of ICH (adjusted OR, aOR 1.06, 95 % CI 1.02-1.1, p < 0.001), higher 24 h NIHSS (aOR 1.22, 95 % CI 1.11-1.34, p < 0.001), ENR (aOR 0.90, 95 % CI 0.82-1.00, p < 0.002), and 90-day mRS (aOR 1.06, 95 % CI 1.03-1.09, p < 0.001) when adjusted for age, presenting NIHSS, ASPECTS, 24-hour peak systolic blood pressure, time from last known well, and successful recanalization.
In the BEST study, increasing BG was associated with greater odds of increasing ICH severity. Further study is warranted to determine whether treatment of will decrease ICH severity following EVT.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biomarkers - blood</subject><subject>Blood Glucose - metabolism</subject><subject>Cerebral Hemorrhage - blood</subject><subject>Cerebral Hemorrhage - diagnosis</subject><subject>Cerebral Hemorrhage - diagnostic imaging</subject><subject>Cerebral Hemorrhage - etiology</subject><subject>Cerebral Hemorrhage - therapy</subject><subject>Disability Evaluation</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Endovascular therapy</subject><subject>Female</subject><subject>Humans</subject><subject>Hyperglycemia</subject><subject>Hyperglycemia - blood</subject><subject>Hyperglycemia - complications</subject><subject>Hyperglycemia - diagnosis</subject><subject>Hyperglycemia - therapy</subject><subject>Intracerebral hemorrhage</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Recovery of Function</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Stroke</subject><subject>Stroke - blood</subject><subject>Stroke - diagnosis</subject><subject>Stroke - physiopathology</subject><subject>Stroke - therapy</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>United States</subject><issn>1052-3057</issn><issn>1532-8511</issn><issn>1532-8511</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqVkU1v1DAQhi0EoqXwF5CPCCmLP9axc4Sq0EorcYGz5Y_JxksSL7azZf89XqVw4sJlZg7PvPPxIvSekg0ltP1w2BxySfEHOEhgUzyZ7EPeMMK2FZCK8WfomgrOGiUofV5rIljDiZBX6FXOB0IoFUq8RFdcKUV4K6_Rr_uwHyBhO8bo8X5cXMyAQ8Ym5-iCKeDxYygDLgPgDCdIoZxx7PEAU0xpMPvgcElmzn1Mkykhztj0pSrC7C8bumU06dKdzPGMK4TXG16jF70ZM7x5yjfo--e7b7f3ze7rl4fbj7vGsbYrTaeEs4z2nXWWOOdVZ2wnt60HaX1LJaGklZYJ3vVdr4hVXEqmaMuAbNXWCX6D3q26xxR_LpCLnkJ2MI5mhrhkzUnbUclqrOinFXUp5pyg18cUJpPOmhJ9cUAf9L8c0BcH9OpAFXn7NG-xE_i_En9eXoHdCkC9-hQg6ewCzA58SOCK9jH8z7zf0ziooA</recordid><startdate>202408</startdate><enddate>202408</enddate><creator>Aziz, Yasmin N</creator><creator>Vagal, Vaibhav</creator><creator>Mehta, Tapan Vijaykumar</creator><creator>Siegler, James E</creator><creator>Mistry, Akshitkumar M</creator><creator>Yaghi, Shadi</creator><creator>Khatri, Pooja</creator><creator>Mistry, Eva A</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202408</creationdate><title>Higher blood glucose is associated with the severity of hemorrhagic transformation after endovascular therapy for stroke</title><author>Aziz, Yasmin N ; Vagal, Vaibhav ; Mehta, Tapan Vijaykumar ; Siegler, James E ; Mistry, Akshitkumar M ; Yaghi, Shadi ; Khatri, Pooja ; Mistry, Eva A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c269t-985cb21f9bcb0ccd89ab9746de7bd61701067b2539f9f80b837728162e0484c53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biomarkers - blood</topic><topic>Blood Glucose - metabolism</topic><topic>Cerebral Hemorrhage - blood</topic><topic>Cerebral Hemorrhage - diagnosis</topic><topic>Cerebral Hemorrhage - diagnostic imaging</topic><topic>Cerebral Hemorrhage - etiology</topic><topic>Cerebral Hemorrhage - therapy</topic><topic>Disability Evaluation</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Endovascular therapy</topic><topic>Female</topic><topic>Humans</topic><topic>Hyperglycemia</topic><topic>Hyperglycemia - blood</topic><topic>Hyperglycemia - complications</topic><topic>Hyperglycemia - diagnosis</topic><topic>Hyperglycemia - therapy</topic><topic>Intracerebral hemorrhage</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Recovery of Function</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Stroke</topic><topic>Stroke - blood</topic><topic>Stroke - diagnosis</topic><topic>Stroke - physiopathology</topic><topic>Stroke - therapy</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Aziz, Yasmin N</creatorcontrib><creatorcontrib>Vagal, Vaibhav</creatorcontrib><creatorcontrib>Mehta, Tapan Vijaykumar</creatorcontrib><creatorcontrib>Siegler, James E</creatorcontrib><creatorcontrib>Mistry, Akshitkumar M</creatorcontrib><creatorcontrib>Yaghi, Shadi</creatorcontrib><creatorcontrib>Khatri, Pooja</creatorcontrib><creatorcontrib>Mistry, Eva A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of stroke and cerebrovascular diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Aziz, Yasmin N</au><au>Vagal, Vaibhav</au><au>Mehta, Tapan Vijaykumar</au><au>Siegler, James E</au><au>Mistry, Akshitkumar M</au><au>Yaghi, Shadi</au><au>Khatri, Pooja</au><au>Mistry, Eva A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Higher blood glucose is associated with the severity of hemorrhagic transformation after endovascular therapy for stroke</atitle><jtitle>Journal of stroke and cerebrovascular diseases</jtitle><addtitle>J Stroke Cerebrovasc Dis</addtitle><date>2024-08</date><risdate>2024</risdate><volume>33</volume><issue>8</issue><spage>107823</spage><pages>107823-</pages><artnum>107823</artnum><issn>1052-3057</issn><issn>1532-8511</issn><eissn>1532-8511</eissn><abstract>•Large vessel occlusion stroke may be particularly vulnerable to the effects of hyperglycemia.•We analyzed intracerebral hemorrhage severity as a result of hyperglycemia-induced toxicity.•Increasing blood glucose was associated with increasing severity of intracerebral hemorrhage.•Future study is needed to determine if glycemic control improves outcomes in this population.
Hyperglycemia is associated with poor outcome in large vessel occlusion (LVO) stroke, with mechanism for this effect unknown.
We used our prospective, multicenter, observational study, Blood Pressure After Endovascular Stroke Therapy (BEST), of anterior circulation LVO stroke undergoing endovascular therapy (EVT) from 11/2017-7/2018 to determine association between increasing blood glucose (BG) and intracerebral hemorrhage (ICH). Our primary outcome was degree of ICH, classified as none, asymptomatic ICH, or symptomatic ICH (≥4-point increase in National Institutes of Health Stroke Scale [NIHSS] at 24 h with any hemorrhage on imaging). Secondary outcomes included 24 h NIHSS, early neurologic recovery (ENR, NIHSS 0-1 or NIHSS reduction by ≥8 within 24 h), and 90-day modified Rankin Scale (mRS) using univariate and multivariable regression.
Of 485 enrolled patients, increasing BG was associated with increasing severity of ICH (adjusted OR, aOR 1.06, 95 % CI 1.02-1.1, p < 0.001), higher 24 h NIHSS (aOR 1.22, 95 % CI 1.11-1.34, p < 0.001), ENR (aOR 0.90, 95 % CI 0.82-1.00, p < 0.002), and 90-day mRS (aOR 1.06, 95 % CI 1.03-1.09, p < 0.001) when adjusted for age, presenting NIHSS, ASPECTS, 24-hour peak systolic blood pressure, time from last known well, and successful recanalization.
In the BEST study, increasing BG was associated with greater odds of increasing ICH severity. Further study is warranted to determine whether treatment of will decrease ICH severity following EVT.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>38880367</pmid><doi>10.1016/j.jstrokecerebrovasdis.2024.107823</doi></addata></record> |
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subjects | Aged Aged, 80 and over Biomarkers - blood Blood Glucose - metabolism Cerebral Hemorrhage - blood Cerebral Hemorrhage - diagnosis Cerebral Hemorrhage - diagnostic imaging Cerebral Hemorrhage - etiology Cerebral Hemorrhage - therapy Disability Evaluation Endovascular Procedures - adverse effects Endovascular therapy Female Humans Hyperglycemia Hyperglycemia - blood Hyperglycemia - complications Hyperglycemia - diagnosis Hyperglycemia - therapy Intracerebral hemorrhage Male Middle Aged Prospective Studies Recovery of Function Risk Assessment Risk Factors Severity of Illness Index Stroke Stroke - blood Stroke - diagnosis Stroke - physiopathology Stroke - therapy Time Factors Treatment Outcome United States |
title | Higher blood glucose is associated with the severity of hemorrhagic transformation after endovascular therapy for stroke |
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