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We studied the relation of reactive hyperglycemia,stress hormone response, and outcome in 23 consecutive elderly patients(mean age 80[range 75-92] years)following an acute first stroke.The medial delay from the onset of the stroke to the first blood sample(day 0)was 9(range 4-22)hours. Subsequent blood samples were taken,after fasting,for the determination of blood glucose,cortisol,catecholamine,insulin,C-peptide,glucagon,and lactate concentrations on days 1,2,3,7,14,30,and 90.For all 23 patients,a significant relation was found between the blood glucose concentration and survival(p=0.03)and the blood glucose concentration decreased with time(p< 0.001).There was also a significant relation between blood glucose concentration and outcome(p=0.02).For the 15 patients with complete data, the major determinants of the blood glucose concentration were the cortisol,insulin,and glucagon concentrations(all p<0.001),which accounted for 42%of the variance.When all the indexes were analyzed together by logistic regression,only the cortisol concentration was related to outcome (p=0.02).Hyperglycemia following a stroke probably reflects the intensity of the stress hormone response.We have confirmed that hyperglycemia is a predictor of outcome in persons with stroke. |
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