Abnormal Blood Glucose Associated With Ischemic Stroke Outcomes in Children

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Abnormal blood glucose linked to ischemic stroke in children.
Abnormal blood glucose linked to ischemic stroke in children.

Children who experienced acute arterial ischemic stroke were more likely to experience abnormal blood pressure, high blood glucose, and/or fever, according to results from a study of patients treated at Vanderbilt Children's Hospital.

Researchers evaluated 98 children treated at Vanderbilt from January 2009 to December 2013. Median age was 6.0 years.

Two definitions for hypertension were used. The first (HTN1) required systolic blood pressure and/or diastolic blood pressure at or above the 95th percentile for age, sex, and height for 2 consecutive recordings within the same day during the first 5 days after the stroke. The second (HTN2) required systolic blood pressure and/or diastolic blood pressure at or above the 95th percentile for age, sex, and height for 2 consecutive recordings and 2 consecutive days within the first 5 days after the stroke.

Blood glucose levels and temperature data were collected from admission through hospital day 5 and hyperglycemia was defined as a blood glucose level of 200 mg/dL. Hyperpyrexia was defined as an axillary temperature at least 37.8°C or a rectal temperature at least 38°C.

The researchers reported that hypertension was prevalent in the study; 83.7% of patients evidenced HTN1 and 65.3% evidenced HTN2. Furthermore, 68.4% of patients displayed hypotension during their hospital stay.

Blood glucose levels were recorded for 94 patients. Seventeen children (18.1%) had a blood glucose level of at least 200 mg/dL. Three children (3.2%) were treated for hypoglycemia, defined as blood glucose of 60 mg/dL or lower.

Thirty-seven patients (37.8%) experienced fever, 35 of whom were treated (94.6%). Sixteen patients (16.3%) had a temperature of at least 39°C. Neither temperature at or above 38°C nor temperature at or above 39°C were associated with poor outcome in this sample.

Infarct volume, especially at least 4% of brain volume, and hyperglycemia were associated with poor neurological outcome (See Table). Forty percent of patients had infarct volumes that were 2% or more of brain volume and 25.8% had infarct volumes that were 4% or more of brain volume.

“We believe that future studies should consider infarct volume when assessing predictors associated with outcome,” the researchers wrote.

Table. Risk Factors Associated With Poor 3-Month Outcome

Condition Odds Ratio (95% CI) P Value
Infarct ≥4% of brain volume 5.6 (2.0-15.4) >.001
HTN2 0.9 (0.36-2.47) .92
Hyperglycemia (≥200 mg/dL) 3.9 (1.2-12.4) .02
Hypoglycemia (≤60 mg/dL) 2.7 (0.73-9.8) .14

Writing in an accompanying editorial, Lauren A. Beslow, MD, MSCE, assistant professor of pediatric neurology at Yale School of Medicine in New Haven, Connecticut, called the findings interesting but said “the present study is unable to answer questions asked at the bedside of nearly every child with stroke, such as, ‘How should blood pressure be managed?'” until more research is done.

She added that the researchers are right to call for additional studies measuring blood pressure, temperature, and blood glucose levels in both in the acute setting and at follow-up.

“This study acts as a reminder to those who care for children with stroke that vital sign changes and abnormal laboratory values could be critical, particularly because they may be modifiable,” Dr Beslow wrote.

“Blood pressure, temperature, and blood glucose levels should be focuses for future study efforts in addition to efforts to prevent recurrence and promote recovery. This study should prompt multicenter prospective studies on each of these factors to improve existing guidelines for management after childhood arterial ischemic stroke.”

References

  1. Grelli KN, Gindville MC, Walker H, Jordan LC. Association of blood pressure, blood glucose, and temperature with neurological outcome after childhood stroke. JAMA Neurol. 2016. doi:10.1001/jamaneurol.2016.0992.
  2. Beslow LA. Back to basics—Vital sign and blood glucose abnormalities and outcome in childhood arterial ischemic stroke. JAMA Neurol. 2016. doi:10.1001/jamaneurol.2016.1054.
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