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OBJECTIVE: To determine the association between admission blood glucose and outcome in ischemic stroke patients treated with thrombolysis. DESIGN: A prospective, open, multinational, observational study. SETTING: An ongoing Internet-based, academic-driven, interactive thrombolysis register. PATIENTS: Between 2002 and 2007, 16 049 patients were recorded in the SITS-ISTR. MAIN OUTCOME MEASURE: Blood glucose was recorded at admission. Blood glucose was divided into the following categories: less than 80, 80-120 (reference range), 121-140, 141-160, 161-180, 181-200, and greater than 200 mg/dL. Outcomes were mortality and independence (modified Rankin Scale score of 0-2) at 3 months and symptomatic intracerebral hemorrhage (SICH) (National Institutes of Health Stroke Scale deterioration ≥4 points within 24 hours and type 2 parenchymal hemorrhage). RESULTS: In multivariable analysis, blood glucose as a continuous variable was independently associated with a higher mortality (P < .001), lower independence (P < .001), and an increased risk of SICH (P = .005). Blood glucose greater than 120 mg/dL as a categorical variable was associated with a significantly higher odds for mortality (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.07-1.44; P = .004) and a lower odds for independence (OR, 0.58; 95% CI, 0.48-0.70; P < .001), and blood glucose from 181 to 200 mg/dL was associated with an increased risk of SICH (OR, 2.86; 95% CI, 1.69-4.83; P < .001) compared with the reference level. The trends of associations between blood glucose and outcomes were similar in patients with diabetes (17%) or without such history, except for mortality (P = .23) and SICH (P = .06) in which the association was not statistically significant in patients with diabetes. CONCLUSIONS: Admission hyperglycemia was an independent predictor for poor outcome after stroke/thrombolysis, though SICH rates did not increase significantly until reaching 180 mg/dL. These results suggest that tight control of blood glucose may be indicated in the hyperacute phase following thrombolysis. Randomized trial data are needed.

Original publication




Journal article


Arch Neurol

Publication Date





1123 - 1130


Blood Glucose, Brain Ischemia, Humans, Hyperglycemia, Injections, Intravenous, Multivariate Analysis, Predictive Value of Tests, Prognosis, Prospective Studies, Registries, Stroke, Thrombolytic Therapy, Time Factors, Treatment Outcome