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The Influence of Hyperglycemia on Outcome of Cerebral Infarction

David B. Matchar, MD; George W. Divine, PhD; Albert Heyman, MD; and John R. Feussner, MD
[+] Article, Author, and Disclosure Information

Grant Support: In part by grant NS 06233 from the National Institute for Neurological Diseases and Stroke.

Requests for Reprints: David B. Matchar, MD, Center for Health Policy Research and Education, Suite 125, Old Chemistry Building, Duke University, Durham, NC 27706.

Current Author Addresses: Dr. Matchar: Center for Health Policy Research and Education, Suite 125, Old Chemistry Building, Duke University, Durham, NC 27706.

Dr. Divine: Henry Ford Health System, Division of Biostatistics, Research Epidemiology and Computing, 23725 Northwestern, Southfield, MI 48075.

Dr. Heyman: Division of Neurology, Department of Medicine, Box 3240, Duke University Medical Center, Durham, NC 27710.

Dr. Feussner: Division of General Internal Medicine, Department of Medicine, Box 3240, Duke University Medical Center, Durham, NC 27710.

Ann Intern Med. 1992;117(6):449-456. doi:10.7326/0003-4819-117-6-449
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Objective: To determine whether hyperglycemia in the acute stroke period is associated with worse survival and functional outcome after accounting for acute stress response and chronic hyperglycemia.

Design: Prospective, county-wide, multicenter cohort study.

Setting: A community hospital, a university hospital, and a Veterans Affairs hospital.

Patients: A cohort of 146 patients hospitalized with new atherothrombotic stroke.

Measurements: Admission blood glucose concentration, demographic characteristics of patients, 24-hour urinary catecholamine, serum cortisol, and glycosylated hemoglobin levels; outcomes included mortality and functional outcome (Barthel index and Fugl-Meyer score) at 5, 30, 90, and 180 days after stroke.

Results: Of the 996 patients with possible acute stroke who were screened, 146 (15%) were eligible for and consented to participate in the study; in most cases, exclusion from study was based on the absence of acute, atherothrombotic stroke. Overall, no evidence was found of a significant univariate association between admission blood glucose level and survival (relative risk, 1.02; 95% Cl, 0.94 to 1.09) or functional outcome (univariate regression coefficient for adjusted Fugl-Meyer score at day 30, - 0.36; Cl, - 1.08 to 0.27). This absence of an association persisted after adjustment for significant predictors of outcome in a multivariate model.

Conclusions: These data do not support an association between level of glycemia and outcome from acute stroke.





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