In-hospital dynamics of glucose, blood pressure and temperature predict outcome in patients with acute ischaemic stroke

Anastasia Skafida; Asimina Mitrakou; Georgios Georgiopoulos; Maria Alevizaki; Konstantinos Spengos; Konstantinos Takis; George Ntaios; Christos Thomadakis; Konstantinos Vemmos

doi:10.1177/2396987318765824

In-hospital dynamics of glucose, blood pressure and temperature predict outcome in patients with acute ischaemic stroke

Eur Stroke J. 2018 Jun;3(2):174-184. doi: 10.1177/2396987318765824. Epub 2018 Mar 16.

Authors

Affiliations

¹ Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Alexandra Hospital, Athens, Greece.
² Department of Neurology, G. Gennimatas General Hospital, Athens, Greece.
³ Department of Neurology, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece.
⁴ Department of Neurology, Mediteraneo Hospital, Athens, Greece.
⁵ 5Department of Medicine, University of Thessaly, Larissa, Greece.
⁶ Department of Hygiene and Epidemiology, National and Kapodistrian University of Athens, Athens, Greece.
⁷ Hellenic Cardiovascular Research Society, Athens, Greece.

Abstract

Introduction: We aimed to assess alterations in glucose, blood pressure and temperature in acute ischaemic stroke and investigate their association with early all-cause mortality and functional outcome.

Patients and methods: We studied all consecutive acute ischaemic stroke patients admitted in 2001-2010 to the Acute Stroke Unit, at Alexandra University Hospital, in Athens. Serial measurements were performed in the first seven days post-stroke and different parameters have been estimated: mean daily values, variability, subject-specific baseline levels and rate of change in serial measurements. Cox-proportional-hazards-model analysis and logistic-regression analysis were applied to investigate the association between these parameters and all-cause mortality and functional outcome after adjustment for known confounders of stroke outcome.

Results: In 1271 patients (mean age 72.3 ± 11.2 years), after adjusting for confounders, baseline glucose levels (HR: 1.005, 95%CI: 1.001-1.01; p = 0.017), variability of systolic BP (SBP) as estimated by standard deviation (HR: 1.028, 95%CI: 1.01-1.048; p = 0.005), the baseline temperature (HR: 2.758, 95%CI: 2.067-3.68; p < 0.001) and the rate of temperature change (HR: 1.841, 95%CI: 1.616-2.908; p < 0.001) were independently associated with all-cause mortality within three months. Poor functional outcome was associated with subject-specific baseline values of temperature (OR: 1.743; 95%CI: 1.076-2.825; p = 0.024), the rate of SBP (OR: 1.159; 95% CI: 1.047-1.280; p = 0.004) and temperature change (OR: 1.402; 95% CI: 1.061-1.853; p = 0.018).

Discussion: The main strength of our study is that we analysed simultaneously three parameters and we used four different variables for each parameter of interest.

Conclusion: Baseline glucose levels, variability of SBP and baseline temperature and its rate of change are independent predictors of all-cause mortality. Baseline values of temperature and the rate of changes in SBP and temperature are independent predictors of poor functional outcome.

Keywords: Acute stroke; blood pressure; hyperglycaemia; mortality; temperature.