Fuentes Blanca, Castillo José, San José Belén, Leira Rogelio, Serena Joaquín, Vivancos José, Dávalos Antonio, Nuñez Antonio Gil, Egido José, Díez-Tejedor Exuperio
Department of Neurology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain.
Stroke. 2009 Feb;40(2):562-8. doi: 10.1161/STROKEAHA.108.519926. Epub 2008 Dec 18.
Evidence is accumulating regarding the prognostic influence of hyperglycemia in patients with acute ischemic stroke. However, the level associated with poor outcome is unknown. Our objectives were to establish the capillary glucose threshold with the highest predictive accuracy of poor outcome and to evaluate its hypothetical value in influencing functional outcome by adjusting for other well-known prognostic factors in acute stroke.
The authors conducted a multicenter, prospective, and observational cohort study of 476 patients with ischemic stroke within less than 24 hours from stroke onset. Capillary finger-prick glucose and stroke severity were determined on admission and 3 times a day during the first 48 hours. Poor outcome (modified Rankin Scale >2) was evaluated at 3 months.
The receiver operating characteristic curves showed the predictive value of maximum capillary glucose at any time within the first 48 hours with an area under the curve of 0.656 (95% CI, 0.592 to 0.720; P<0.01) and pointed to 155 mg/dL as the optimal cutoff level for poor outcome at 3 months (53% sensitivity; 73% specificity). This point was associated with a 2.7-fold increase (95% CI, 1.42 to 5.24) in the odds of poor outcome after adjustment for age, diabetes, capillary glucose on admission, infarct volume, and baseline stroke severity and with a 3-fold increase in the risk of death at 3 months (hazard ratio, 3.80; 95% CI, 1.79 to 8.10).
Hyperglycemia >or=155 mg/dL at any time within the first 48 hours from stroke onset, and not only the isolated value of admission glycemia, is associated with poor outcome independently of stroke severity, infarct volume, diabetes, or age.
关于高血糖对急性缺血性脑卒中患者预后影响的证据正在不断积累。然而，与不良预后相关的血糖水平尚不清楚。我们的目标是确定对不良预后具有最高预测准确性的毛细血管血糖阈值，并通过调整急性卒中其他已知的预后因素来评估其对功能预后的假设价值。
作者对476例发病24小时内的缺血性脑卒中患者进行了一项多中心、前瞻性观察队列研究。入院时及发病后48小时内每天3次测定毛细血管血糖和卒中严重程度。在3个月时评估不良预后（改良Rankin量表评分>2）。
受试者工作特征曲线显示，发病后48小时内任何时间的最大毛细血管血糖的预测价值，曲线下面积为0.656（95%可信区间，0.592至0.720；P<0.01），并指出155mg/dL为3个月时不良预后的最佳截断水平（敏感性53%；特异性73%）。在校正年龄、糖尿病、入院时毛细血管血糖、梗死体积和基线卒中严重程度后，这一血糖水平与不良预后几率增加2.7倍（95%可信区间，1.42至5.24）相关，与3个月时死亡风险增加3倍相关（风险比，3.80；95%可信区间，1.79至8.10）。
卒中发病后48小时内任何时间血糖≥155mg/dL，不仅是入院时血糖孤立值，与不良预后相关，且独立于卒中严重程度、梗死体积、糖尿病或年龄。
