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Elevated blood glucose is associated with aggravated brain edema in acute stroke

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Elevated blood glucose is associated with aggravated brain edema in acute stroke. / Broocks, Gabriel; Kemmling, Andre; Aberle, Jens; Kniep, Helge; Bechstein, Matthias; Flottmann, Fabian; Leischner, Hannes; Faizy, Tobias D; Nawabi, Jawed; Schön, Gerhard; Sporns, Peter; Thomalla, Götz; Fiehler, Jens; Hanning, Uta.

In: J NEUROL, Vol. 267, No. 2, 02.2020, p. 440-448.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Broocks, G, Kemmling, A, Aberle, J, Kniep, H, Bechstein, M, Flottmann, F, Leischner, H, Faizy, TD, Nawabi, J, Schön, G, Sporns, P, Thomalla, G, Fiehler, J & Hanning, U 2020, 'Elevated blood glucose is associated with aggravated brain edema in acute stroke', J NEUROL, vol. 267, no. 2, pp. 440-448. https://doi.org/10.1007/s00415-019-09601-9

APA

Broocks, G., Kemmling, A., Aberle, J., Kniep, H., Bechstein, M., Flottmann, F., Leischner, H., Faizy, T. D., Nawabi, J., Schön, G., Sporns, P., Thomalla, G., Fiehler, J., & Hanning, U. (2020). Elevated blood glucose is associated with aggravated brain edema in acute stroke. J NEUROL, 267(2), 440-448. https://doi.org/10.1007/s00415-019-09601-9

Vancouver

Broocks G, Kemmling A, Aberle J, Kniep H, Bechstein M, Flottmann F et al. Elevated blood glucose is associated with aggravated brain edema in acute stroke. J NEUROL. 2020 Feb;267(2):440-448. https://doi.org/10.1007/s00415-019-09601-9

Bibtex

@article{653a4575a95d416bb0cee918484d5f99,
title = "Elevated blood glucose is associated with aggravated brain edema in acute stroke",
abstract = "BACKGROUND AND PURPOSE: Clinical outcome after endovascular thrombectomy in patients with acute ischemic stroke still varies significantly. Higher blood glucose levels (BGL) have been associated with worse clinical outcome, but the pathophysiological causes are not yet understood. We hypothesized that higher levels of BGL are associated with more pronounced ischemic brain edema and worse clinical outcome mediated by cerebral collateral circulation.METHODS: 178 acute ischemic stroke patients who underwent mechanical thrombectomy were included. Early ischemic brain edema was determined using quantitative lesion water uptake on initial computed tomography (CT) and collateral status was assessed with an established 5-point scoring system in CT-angiography. Good clinical outcome was defined as functional independence (modified Rankin Scale [mRS] score 0-2). Multivariable logistic regression analysis was performed to predict functional independence and linear regression analyses to investigate the impact of BGL and collateral status on water uptake.RESULTS: The mean BGL at admission was significantly lower in patients with good outcome at 90 days (116.5 versus 138.5 mg/dl; p < 0.001) and early water uptake was lower (6.3% versus 9.6%; p < 0.001). The likelihood for good outcome declined with increasing BGL (odds ratio [OR] per 100 mg/dl BGL increase: 0.15; 95% CI 0.02-0.86; p = 0.039). Worse collaterals (1% water uptake per point, 95% CI 0.4-1.7%) and higher BGL (0.6% per 10 mg/dl BGL, 95% CI 0.3-0.8%) were significantly associated with increased water uptake.CONCLUSION: Elevated admission BGL were associated with increased early brain edema and poor clinical outcome mediated by collateral status. Patients with higher BGL might be targeted by adjuvant anti-edematous treatment.",
author = "Gabriel Broocks and Andre Kemmling and Jens Aberle and Helge Kniep and Matthias Bechstein and Fabian Flottmann and Hannes Leischner and Faizy, {Tobias D} and Jawed Nawabi and Gerhard Sch{\"o}n and Peter Sporns and G{\"o}tz Thomalla and Jens Fiehler and Uta Hanning",
year = "2020",
month = feb,
doi = "10.1007/s00415-019-09601-9",
language = "English",
volume = "267",
pages = "440--448",
journal = "J NEUROL",
issn = "0340-5354",
publisher = "D. Steinkopff-Verlag",
number = "2",

}

RIS

TY - JOUR

T1 - Elevated blood glucose is associated with aggravated brain edema in acute stroke

AU - Broocks, Gabriel

AU - Kemmling, Andre

AU - Aberle, Jens

AU - Kniep, Helge

AU - Bechstein, Matthias

AU - Flottmann, Fabian

AU - Leischner, Hannes

AU - Faizy, Tobias D

AU - Nawabi, Jawed

AU - Schön, Gerhard

AU - Sporns, Peter

AU - Thomalla, Götz

AU - Fiehler, Jens

AU - Hanning, Uta

PY - 2020/2

Y1 - 2020/2

N2 - BACKGROUND AND PURPOSE: Clinical outcome after endovascular thrombectomy in patients with acute ischemic stroke still varies significantly. Higher blood glucose levels (BGL) have been associated with worse clinical outcome, but the pathophysiological causes are not yet understood. We hypothesized that higher levels of BGL are associated with more pronounced ischemic brain edema and worse clinical outcome mediated by cerebral collateral circulation.METHODS: 178 acute ischemic stroke patients who underwent mechanical thrombectomy were included. Early ischemic brain edema was determined using quantitative lesion water uptake on initial computed tomography (CT) and collateral status was assessed with an established 5-point scoring system in CT-angiography. Good clinical outcome was defined as functional independence (modified Rankin Scale [mRS] score 0-2). Multivariable logistic regression analysis was performed to predict functional independence and linear regression analyses to investigate the impact of BGL and collateral status on water uptake.RESULTS: The mean BGL at admission was significantly lower in patients with good outcome at 90 days (116.5 versus 138.5 mg/dl; p < 0.001) and early water uptake was lower (6.3% versus 9.6%; p < 0.001). The likelihood for good outcome declined with increasing BGL (odds ratio [OR] per 100 mg/dl BGL increase: 0.15; 95% CI 0.02-0.86; p = 0.039). Worse collaterals (1% water uptake per point, 95% CI 0.4-1.7%) and higher BGL (0.6% per 10 mg/dl BGL, 95% CI 0.3-0.8%) were significantly associated with increased water uptake.CONCLUSION: Elevated admission BGL were associated with increased early brain edema and poor clinical outcome mediated by collateral status. Patients with higher BGL might be targeted by adjuvant anti-edematous treatment.

AB - BACKGROUND AND PURPOSE: Clinical outcome after endovascular thrombectomy in patients with acute ischemic stroke still varies significantly. Higher blood glucose levels (BGL) have been associated with worse clinical outcome, but the pathophysiological causes are not yet understood. We hypothesized that higher levels of BGL are associated with more pronounced ischemic brain edema and worse clinical outcome mediated by cerebral collateral circulation.METHODS: 178 acute ischemic stroke patients who underwent mechanical thrombectomy were included. Early ischemic brain edema was determined using quantitative lesion water uptake on initial computed tomography (CT) and collateral status was assessed with an established 5-point scoring system in CT-angiography. Good clinical outcome was defined as functional independence (modified Rankin Scale [mRS] score 0-2). Multivariable logistic regression analysis was performed to predict functional independence and linear regression analyses to investigate the impact of BGL and collateral status on water uptake.RESULTS: The mean BGL at admission was significantly lower in patients with good outcome at 90 days (116.5 versus 138.5 mg/dl; p < 0.001) and early water uptake was lower (6.3% versus 9.6%; p < 0.001). The likelihood for good outcome declined with increasing BGL (odds ratio [OR] per 100 mg/dl BGL increase: 0.15; 95% CI 0.02-0.86; p = 0.039). Worse collaterals (1% water uptake per point, 95% CI 0.4-1.7%) and higher BGL (0.6% per 10 mg/dl BGL, 95% CI 0.3-0.8%) were significantly associated with increased water uptake.CONCLUSION: Elevated admission BGL were associated with increased early brain edema and poor clinical outcome mediated by collateral status. Patients with higher BGL might be targeted by adjuvant anti-edematous treatment.

U2 - 10.1007/s00415-019-09601-9

DO - 10.1007/s00415-019-09601-9

M3 - SCORING: Journal article

C2 - 31667625

VL - 267

SP - 440

EP - 448

JO - J NEUROL

JF - J NEUROL

SN - 0340-5354

IS - 2

ER -