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
Hauptverfasser: Aziz, Yasmin N, Vagal, Vaibhav, Mehta, Tapan Vijaykumar, Siegler, James E, Mistry, Akshitkumar M, Yaghi, Shadi, Khatri, Pooja, Mistry, Eva A
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container_issue 8
container_start_page 107823
container_title Journal of stroke and cerebrovascular diseases
container_volume 33
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. 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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. 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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 &lt; 0.001), higher 24 h NIHSS (aOR 1.22, 95 % CI 1.11-1.34, p &lt; 0.001), ENR (aOR 0.90, 95 % CI 0.82-1.00, p &lt; 0.002), and 90-day mRS (aOR 1.06, 95 % CI 1.03-1.09, p &lt; 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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