Detrimental Effect of Acute Hyperglycemia on the Outcomes of Large Ischemic Region Stroke

BACKGROUND: Although endovascular therapy (EVT) is effective for large ischemic region strokes, the impact of hyperglycemia remains unclear. METHODS AND RESULTS: We analyzed data from the RESCUE-Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism-Japan Large Ischemic Core) trial, which randomized stroke patients with Alberta Stroke Program Early Computed Tomography Score of 3 to 5 to EVT versus medical management. Outcomes were compared among patients with normoglycemia (<140 mg/dL), moderate hyperglycemia (≥140, <180 mg/dL), and severe hyperglycemia (≥180 mg/dL) on admission. Among 200 patients (median age 76.5 years, median glucose level 131 mg/dL, EVT 50%), diabetes prevalence was 10.0%, 18.4%, and 71.0% in the groups with normoglycemia (n=120), moderate hyperglycemia (n=49), and severe hyperglycemia (n=31), respectively. Achievement of modified Rankin Scale score 0 to 3 at 90 days was less frequent in the group with severe hyperglycemia (6.5%) than in the groups with normoglycemia (25.0%) and moderate hyperglycemia (24.5%), with adjusted odds ratios (aOR) of 1.48 (95% CI, 0.59-3.72) for moderate and 0.17 (95% CI, 0.03-0.95) for severe hyperglycemia relative to normoglycemia. The risk of symptomatic intracranial hemorrhage was higher for moderate hyperglycemia (6.1%; aOR, 2.86 [95% CI, 0.42-19.71]) and particularly for severe hyperglycemia (25.8%; aOR, 18.59 [95% CI, 2.47-139.87]) compared with normoglycemia (2.5%). Symptomatic intracranial hemorrhage rates were similar for EVT and medical management in normoglycemia (1.6% versus 3.4%) and moderate hyperglycemia (5.0% versus 6.9%), but for severe hyperglycemia, the rate was higher in patients with EVT (36.8%) than in those without (8.3%). CONCLUSIONS: Severe hyperglycemia was associated with worse functional prognosis and increased symptomatic intracranial hemorrhage in large ischemic region strokes. REGISTRATION: URL: https://clinicaltrials.gov. Identifier: NCT03702413.