Moderate hyperglycaemia is associated with favourable outcome in acute lacunar stroke
1Departments of Neurology and 2Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
Correspondence to: Professor J. De Keyser, PhD, Department of Neurology, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands. E-mail: j.h.a.de.keyser{at}neuro.umcg.nl
Hyperglycaemia in acute ischaemic stroke is traditionally associated with a worsened outcome. However, it is unclear whether the impact of hyperglycaemia on stroke outcome is similar in lacunar and non-lacunar infarctions.
The relation between serum glucose measured within 6 h after stroke onset and functional outcome was investigated in 1375 ischaemic stroke patients who had been included in two placebo-controlled trials with lubeluzole. The endpoint was a favourable outcome, defined as a modified Rankin Scale score 
2 at 3 months. Classification into lacunar (n = 168) and non-lacunar (n = 1207) strokes was based on clinical criteria according to the Oxfordshire Community Stroke Project and findings on brain CT scan. Hyperglycaemia was defined as blood glucose >8 mmol/l. A possible concentration-dependent effect of glucose on outcome was investigated in both lacunar and non-lacunar stroke.
Multivariate analysis showed that hyperglycaemia was associated with decreased odds of a favourable outcome in non-lacunar stroke (OR 0.60; 95% CI 0.41–0.88, P = 0.009), but with increased odds of a favourable outcome in lacunar stroke (multivariate OR for glucose >8 mmol/l: 2.70; 95% CI 1.01–7.13, P = 0.048). In non-lacunar stroke, there appeared to be a concentration–effect relation, as the odds of favourable outcome gradually decreased with increasing glucose levels. In lacunar stroke, an association with favourable outcome was observed with glucose levels >8 mmol/l, but this beneficial effect diminished with more severe hyperglycaemia >12 mmol/l.
In conclusion, hyperglycaemia has a detrimental effect in non-lacunar stroke, but moderate hyperglycaemia may be beneficial in lacunar stroke.
Key Words: ischaemic stroke; hyperglycaemia; lacunar stroke; stroke subtype
Abbreviations: CGI, clinical global impression; CT, computed tomography; NSE, neuron-specific enolase
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