Stress Hyperglycemia and Prognosis of Stroke in Nondiabetic and Diabetic Patients

作者：Sarah E. Capes, Dereck Hunt, Klas Malmberg, Parbeen Pathak, Hertzel C. Gerstein · 发表于：Stroke · 年份：2001 · DOI：10.1161/hs1001.096194 · 被引用次数：1867 · 研究领域：Acute Ischemic Stroke Management、Hyperglycemia and glycemic control in critically ill and hospitalized patients、Neurological and metabolic disorders

BACKGROUND AND PURPOSE: "Stress" hyperglycemia may be associated with increased mortality and poor recovery in diabetic and nondiabetic patients after stroke. A systematic review and meta-analysis of the literature relating acute poststroke glucose levels to the subsequent course were done to summarize and quantify this relationship. METHODS: A comprehensive literature search was done for cohort studies reporting mortality and/or functional recovery after stroke in relation to admission glucose level. Relative risks in hyperglycemic compared with normoglycemic patients with and without diabetes were calculated and meta-analyzed when possible. RESULTS: Thirty-two studies were identified; relative risks for prespecified outcomes were reported or could be calculated in 26 studies. After stroke of either subtype (ischemic or hemorrhagic), the unadjusted relative risk of in-hospital or 30-day mortality associated with admission glucose level >6 to 8 mmol/L (108 to 144 mg/dL) was 3.07 (95% CI, 2.50 to 3.79) in nondiabetic patients and 1.30 (95% CI, 0.49 to 3.43) in diabetic patients. After ischemic stroke, admission glucose level >6.1 to 7.0 mmol/L (110 to 126 mg/dL) was associated with increased risk of in-hospital or 30-day mortality in nondiabetic patients only (relative risk=3.28; 95% CI, 2.32 to 4.64). After hemorrhagic stroke, admission hyperglycemia was not associated with higher mortality in either diabetic or nondiabetic patients. Nondiabetic stroke survivors whose admissi...