Stroke: a tenth of patients with ischaemic stroke died within a month.

Clinical bottom line (level 1b-)

  1. Nearly a tenth of patients with ischaemic stroke had died at 30 days.
  2. Hyperglycaemia was not found to be an independent factor for increased risk of death in ischaemic stroke.
Matchar et al: Annals of Internal Medicine 1992; 117: 449-456
Expires December 2002

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: three centres, USA

146 patients (aged mean 67 years, 61% male) ischaemic stroke and admitted between January 1987 and October 1989

Excluded if
  • risk factors for embolic stroke, including cardiomyopathy, anterior MI in the previous 6 months, atrial fibrillation and presence of prosthetic heart valve
  • very high risk of recurrence
  • haemorrhagic stroke
  • aged = 40 years
  • did not live within 100 miles of one of a specific medical centre
  • preexisting stroke deficit
  • not hospitalised within 24 hours after onset of neurological symptoms
  • no measurable deficit at admission
  • deficit not persisting more than 24 hours
  • medical condition in which death was likely in the next 6 months
  • no informed consent




    • Multivariate analysis was used to adjust for confounding factors.

    100% followed for 30 days
    Outcomes studied:
  • mortality

    • 71% of patients were white.

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    mortality 30 days 13/146 8.90%
    (4.28% to 13.5%)

    • Mean adjusted Fugl-Meyer Score for patients with an admission blood glucose < or = 6.7 mmol/L was 90.
    • Mean adjusted Fugl-Meyer score for patients with an admission blood glucose >6.7 mmol/L was 94.

    Comments

    1. Hyperglycaemia at admission was not found to be an independent factor with multivariate analysis.

    Citation

    1. Matchar DB, Divine GW, Heyman A, et al: The influence of hyperglycemia on outcome of cerebral infarction. Annals of Internal Medicine 1992; 117: 449-456
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer:

    Clinical Question.
    Patient acute stroke
    Intervention or Exposure presence of hyperglycaemiahyperglycemia
    Comparison absence of hyperglycaemia hyperglycemia
    Outcome physical function and mortality