Neurologic Clinic, University of Perugia, Perugia, Italy.
J Diabetes Complications. 2012 Mar-Apr;26(2):70-6. doi: 10.1016/j.jdiacomp.2012.03.001. Epub 2012 Apr 10.
Admission hyperglycemia increases the risk of death in patients with acute stroke. However, the most appropriate cut-off of glucose level indicating an increased risk of short-term mortality remains unknown.
We aimed at establishing the optimum cut-offs of several variables (including admission blood glucose levels) predicting case-fatality (72hours, 7days) and unfavorable outcome [modified Rankin Scale (mRS) score 5-6 at 7 days] in consecutive first-ever acute ischemic stroke. Receiver operating characteristic (ROC) curves were constructed.
Eight hundred eleven consecutive patients were included [median age of 77 (69-83) years; 418 (52%) male; 239 (30%) diabetics; median admission National Institutes of Health Stroke Scale (NIHSS) 7 (4-12), 32 (4%) dead within 72hours; 64 (8%) dead within day 7; 155 (19%) with unfavorable outcome]. Median admission glucose levels were 113 (97-155)mg/dL. Diabetics had significantly higher median glucose levels than non-diabetics [163 (133-214) vs. 107 (92-123) mg/dL, p<0.001]. According to ROC analysis, the only significant predictive value of glycemia was ≥143mg/dL for 72-hour fatality (sensitivity 88% and specificity 70%) especially in non-diabetics (sensitivity 88% and sensitivity 62%). This cut-off point was an independent predictor for 72-hour fatality (overall: OR=4.0, CI=1.6-9.9, p=0.003; non-diabetics: OR=4.9, CI=1.7-14.5, p=0.004). The cut-offs of fasting total cholesterol levels and admission leukocytes had poor predictive values for each outcome, while those of admission NIHSS had good discrimination in predicting short-term outcome measures.
Admission hyperglycemia (≥143mg/dL) is a strong and an independent predictor for 72-hour fatality, especially in patients with no prior history of diabetes mellitus.
入院时的高血糖会增加急性脑卒中患者死亡的风险。然而，能够预测短期死亡率的最佳血糖水平切点仍不清楚。
我们旨在确定一系列变量（包括入院时血糖水平）的最佳切点，以预测首次发生的急性缺血性脑卒中患者的病死率（72 小时、7 天）和不良结局（7 天改良 Rankin 量表评分 5-6）。构建受试者工作特征（ROC）曲线。
共纳入 811 例连续患者[中位年龄 77（69-83）岁；418 例（52%）男性；239 例（30%）糖尿病患者；中位入院国立卫生研究院卒中量表（NIHSS）评分 7（4-12），72 小时内死亡 32 例（4%），7 天内死亡 64 例（8%），不良结局 155 例（19%）]。入院时血糖中位数为 113（97-155）mg/dL。糖尿病患者的血糖中位数明显高于非糖尿病患者[163（133-214）vs. 107（92-123）mg/dL，p<0.001]。根据 ROC 分析，血糖对 72 小时病死率有唯一显著的预测价值，切点为≥143mg/dL（敏感性 88%，特异性 70%），特别是在非糖尿病患者中（敏感性 88%，敏感性 62%）。该切点是非糖尿病患者 72 小时病死率的独立预测因素（总体：OR=4.0，95%CI=1.6-9.9，p=0.003；非糖尿病患者：OR=4.9，95%CI=1.7-14.5，p=0.004）。空腹总胆固醇水平和入院白细胞计数的切点对每种结局的预测值均较差，而入院 NIHSS 切点对短期预后指标的预测具有良好的区分度。
入院时高血糖（≥143mg/dL）是 72 小时病死率的一个强有力的独立预测因素，尤其是在没有糖尿病既往史的患者中。
