High glucose predicts poor outcomes after endovascular treatment for stroke

Patients with acute ischaemic stroke undergoing endovascular treatment (EVT) are at heightened risk of poor functional outcome and symptomatic intracranial haemorrhage (sICH) in the presence of hyperglycaemia at admission, a study has found.

The study used data from the MR CLEAN Registry and included 2,908 patients. The median admission glucose was 6.8 mmol/L, and 882 patients (30 percent) had hyperglycaemia (≥7.8 mmol/L).

Patients with vs without hyperglycaemia were more likely to be older (73 vs 71 years), female (51 percent vs 47 percent), to have a history of diabetes (36 percent vs 7 percent) or hypertension (62 percent vs 49 percent), have higher median NIHSS scores at baseline (16 vs 15) and longer median onset-to-groin times (209 vs 191 minutes).

Compared with normal glucose levels, hyperglycaemia on admission was associated with a greater likelihood of worse EVT outcomes, such as disability (median modified Rankin Scale score, 4 vs 3; adjusted odds ratio [aOR], 1.69, 95 percent confidence interval [CI], 1.44–1.99), increased mortality (40 percent vs 23 percent; aOR, 1.95, 95 percent CI, 1.60–2.38), and an increased risk of symptomatic intracranial haemorrhage (9 percent vs 5 percent; aOR, 1.94, 95 percent CI, 1.41–2.66).

Of note, admission glucose levels and poor functional outcome (modified Rankin Scale score 3–6) had a J-shaped association. The nadir glucose level was 6 mmol/L, and there were different associations for patients with admission glucose levels <6, 6–9, and >9 mmol/L.

Meanwhile, hyperglycaemia did not predict the success of reperfusion, and neither did successful reperfusion modified the association between glucose and functional outcome.

More studies are needed to determine whether patients undergoing EVT may benefit from early intensive glucose-lowering therapy.