Background and Aims: Hyperglycemia in acute ischemic stroke decreases the effectiveness of intravenous tissue plasminogen activator (IV-tPA) therapy and increases its hemorrhagic complications.Therefore, optimization of blood glucose (BG) is suggested. But, no consensus is achieved on what BG parameters to be used such as admission BG, post-treatment BG, first day maximum and average BG (maxBG and aveBG), or BG variability indices such as the standard deviation of mean BG (SDBG), coefficient of variation of BG (CVBG) orJ-index. Methods: Admission and 24h BG were measured in 145 acute stroke patients (56% female, age: 70±13; NIHSS: 14±6) treated with IV-tPA. BG variability indices were calculated in those 107 with serial BG measurements available. Results: Diabetes history was elicited in 25% of patients. Hemoglobin-A1c (HbA1c) was 7.2±1.5% in diabetics and 5.8±0.6% in non-diabetics. AveBG (145±51 vs 124±34 mg/dl, p=0.004) was significantly higher in patients with 3rd month mRS>2 (53.4%), but admission BG, SDBG, CVBG and J-index were not. An exploratory regression analysis indicated that connection of aveBG to worse prognosis ( -0.155, p=0.045) survived after adjustment of admission NIHSS, age and DM history. No BG parameter predicted symptomatic tPA-associated type-II intracerebral hemorrhage (6.8%), albeit they had numerically higher average BG levels (161±37 vs. 133±44 mg/dl, p=0.04). Presence of diabetes, HbA1c, admission BG, average first day BG and variability indices had not modified the beneficial (52%) and dramatic response (29%) to IV tPA. Conclusions:Sustained hyperglycemia, not glucose variability, during the first 24 hour predicts poor prognosis in acute stroke patients treated with IV thrombolysis.
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