Association of Baseline Hyperglycaemia with Outcomes of Diabetic and Non-diabetic Acute Ischaemic Stroke Patients treated with Intravenous Thrombolysis: a Propensity Score Matched Analysis from the SITS-ISTR registry

Georgios Tsivgoulis (Corresponding Author), Aristeidis 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 hyperglycaemia (aHG) with outcomes of acute ischaemic stroke (AIS) patients 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 haemorrhage (SICH); three-month functional independence (FI;mRS scores 0-2) represented the primary efficacy outcome. Patients with and without aHG did not differ in baseline characteristics both in the non-diabetic (n=12,318) and diabetic (n=6,572) PSM subgroups. In the non-DM group, patients with aHG had lower 3- month FI (53.3% vs. 57.9%,p<0.001) rates, higher 3-month mortality rates (19.2% vs. 16.0%,p<0.001) and similar SICH rates (1.7% vs. 1.8%,p=0.563) compared to patients without aHG. Similarly, in the DM group, patients with aHG had lower rates of 3-month favourable 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 to patients without aHG. In conclusion, aHG was associated with unfavorable 3 month clinical outcomes in both diabetic and non-diabetic AIS patients treated with IVT.
Original languageEnglish
Pages (from-to)1861-1869
Number of pages9
JournalDiabetes
Volume68
Issue number9
Early online date19 Jun 2019
DOIs
Publication statusPublished - Sep 2019

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

Keywords

  • acute ischaemic stroke
  • hyperglycaemia
  • diabetes mellitus
  • mortality
  • functional outcome
  • intracranial hemorrhage
  • OXIDATIVE STRESS
  • ACTIVATION
  • MANAGEMENT
  • POSTSTROKE HYPERGLYCEMIA
  • ALTEPLASE
  • SAFE IMPLEMENTATION
  • GLUCOSE
  • PREDICTORS
  • SYMPTOMATIC INTRACRANIAL HEMORRHAGE
  • ADMISSION HYPERGLYCEMIA

Cite this

Association of Baseline Hyperglycaemia with Outcomes of Diabetic and Non-diabetic Acute Ischaemic Stroke Patients treated with Intravenous Thrombolysis : a Propensity Score Matched Analysis from the SITS-ISTR registry. / Tsivgoulis, Georgios (Corresponding Author); Katsanos, Aristeidis; 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, 09.2019, p. 1861-1869.

Research output: Contribution to journalArticle

Tsivgoulis, Georgios ; Katsanos, Aristeidis ; Mavridis, Dimitris ; Lambadiari, Vaia ; Roffe, Christine ; Macleod, Mary Joan ; Sevcik, Petr ; Cappellari, Manuel ; Nevšímalová, Miroslava ; Toni, Danilo ; Ahmed , Niaz . / Association of Baseline Hyperglycaemia with Outcomes of Diabetic and Non-diabetic Acute Ischaemic Stroke Patients 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 hyperglycaemia (aHG) with outcomes of acute ischaemic stroke (AIS) patients 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 haemorrhage (SICH); three-month functional independence (FI;mRS scores 0-2) represented the primary efficacy outcome. Patients with and without aHG did not differ in baseline characteristics both in the non-diabetic (n=12,318) and diabetic (n=6,572) PSM subgroups. In the non-DM group, patients with aHG had lower 3- month FI (53.3{\%} vs. 57.9{\%},p<0.001) rates, higher 3-month mortality rates (19.2{\%} vs. 16.0{\%},p<0.001) and similar SICH rates (1.7{\%} vs. 1.8{\%},p=0.563) compared to patients without aHG. Similarly, in the DM group, patients with aHG had lower rates of 3-month favourable 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 to patients without aHG. In conclusion, aHG was associated with unfavorable 3 month clinical outcomes in both diabetic and non-diabetic AIS patients treated with IVT.",
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T1 - Association of Baseline Hyperglycaemia with Outcomes of Diabetic and Non-diabetic Acute Ischaemic Stroke Patients treated with Intravenous Thrombolysis

T2 - a Propensity Score Matched Analysis from the SITS-ISTR registry

AU - Tsivgoulis, Georgios

AU - Katsanos, Aristeidis

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

N1 - © 2019 by the American Diabetes Association.

PY - 2019/9

Y1 - 2019/9

N2 - Available data from observational studies on the association of admission hyperglycaemia (aHG) with outcomes of acute ischaemic stroke (AIS) patients 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 haemorrhage (SICH); three-month functional independence (FI;mRS scores 0-2) represented the primary efficacy outcome. Patients with and without aHG did not differ in baseline characteristics both in the non-diabetic (n=12,318) and diabetic (n=6,572) PSM subgroups. In the non-DM group, patients with aHG had lower 3- month FI (53.3% vs. 57.9%,p<0.001) rates, higher 3-month mortality rates (19.2% vs. 16.0%,p<0.001) and similar SICH rates (1.7% vs. 1.8%,p=0.563) compared to patients without aHG. Similarly, in the DM group, patients with aHG had lower rates of 3-month favourable 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 to patients without aHG. In conclusion, aHG was associated with unfavorable 3 month clinical outcomes in both diabetic and non-diabetic AIS patients treated with IVT.

AB - Available data from observational studies on the association of admission hyperglycaemia (aHG) with outcomes of acute ischaemic stroke (AIS) patients 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 haemorrhage (SICH); three-month functional independence (FI;mRS scores 0-2) represented the primary efficacy outcome. Patients with and without aHG did not differ in baseline characteristics both in the non-diabetic (n=12,318) and diabetic (n=6,572) PSM subgroups. In the non-DM group, patients with aHG had lower 3- month FI (53.3% vs. 57.9%,p<0.001) rates, higher 3-month mortality rates (19.2% vs. 16.0%,p<0.001) and similar SICH rates (1.7% vs. 1.8%,p=0.563) compared to patients without aHG. Similarly, in the DM group, patients with aHG had lower rates of 3-month favourable 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 to patients without aHG. In conclusion, aHG was associated with unfavorable 3 month clinical outcomes in both diabetic and non-diabetic AIS patients treated with IVT.

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KW - GLUCOSE

KW - PREDICTORS

KW - SYMPTOMATIC INTRACRANIAL HEMORRHAGE

KW - ADMISSION HYPERGLYCEMIA

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JO - Diabetes

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