Zonneveld Thomas P, Nederkoorn Paul J, Westendorp Willeke F, Brouwer Matthijs C, van de Beek Diederik, Kruyt Nyika D
From the Department of Neurology (T.P.Z., P.J.N., W.F.W., M.C.B., D.v.d.B.), Academic Medical Center, Amsterdam; and the Department of Neurology (N.D.K.), Leiden University Medical Center, the Netherlands.
Neurology. 2017 Apr 11;88(15):1415-1421. doi: 10.1212/WNL.0000000000003811. Epub 2017 Mar 10.
To investigate whether admission hyperglycemia predicts poststroke infections and, if so, whether poststroke infections modify the effect of admission hyperglycemia on functional outcome in ischemic stroke.
We used data from acute ischemic stroke patients in the Preventive Antibiotics in Stroke Study (PASS), a multicenter randomized controlled trial (n = 2,550) investigating the effect of preventive antibiotics on functional outcome. Admission hyperglycemia was defined as blood glucose ≥7.8 mmol/L and poststroke infection as any infection during admission judged by an expert adjudication committee. Functional outcome at 3 months was assessed with the modified Rankin Scale.
Of 1,676 nondiabetic ischemic stroke patients, 338 (20%) had admission hyperglycemia. After adjustment for potential confounding variables, admission hyperglycemia was associated with poststroke infection (adjusted odds ratio [aOR] 2.31, 95% CI 1.31-4.07), worse 3-month functional outcome (common aOR 1.40, 95% CI 1.12-1.73), and 3-month mortality (aOR 2.11, 95% CI 1.40-3.19). Additional adjustment for poststroke infection in the functional outcome analysis, done to assess poststroke infection as an intermediate in the pathway from admission hyperglycemia to functional outcome, did not substantially change the model. In patients with recorded diabetes mellitus (n = 418), admission hyperglycemia was not associated with poststroke infection (aOR 0.49, 95% CI 0.15-1.58).
In nondiabetic acute ischemic stroke patients, admission hyperglycemia is associated with poststroke infection and worse functional outcome. Poststroke infections did not modify the effect of admission hyperglycemia on functional outcome in ischemic stroke.
探讨入院时高血糖是否可预测卒中后感染，若如此，卒中后感染是否会改变入院时高血糖对缺血性卒中功能结局的影响。
我们使用了卒中预防性抗生素研究（PASS）中急性缺血性卒中患者的数据，这是一项多中心随机对照试验（n = 2550），旨在研究预防性抗生素对功能结局的影响。入院时高血糖定义为血糖≥7.8 mmol/L，卒中后感染定义为由专家判定委员会判定的入院期间的任何感染。采用改良Rankin量表评估3个月时的功能结局。
在1676例非糖尿病缺血性卒中患者中，338例（20%）入院时高血糖。在对潜在混杂变量进行校正后，入院时高血糖与卒中后感染相关（校正比值比[aOR] 2.31，95%可信区间[CI] 1.31 - 4.07）、3个月时功能结局较差（共同aOR 1.40，95% CI 1.12 - 1.73）以及3个月死亡率相关（aOR 2.11，95% CI 1.40 - 3.19）。在功能结局分析中对卒中后感染进行额外校正，以评估卒中后感染作为从入院时高血糖到功能结局路径中的一个中间因素，并未对模型产生实质性改变。在有糖尿病记录的患者（n = 418）中，入院时高血糖与卒中后感染无关（aOR 0.49，95% CI 0.15 - 1.58）。
在非糖尿病急性缺血性卒中患者中，入院时高血糖与卒中后感染及较差的功能结局相关。卒中后感染并未改变入院时高血糖对缺血性卒中功能结局的影响。
