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Hyperglycemia, infarct volume linked to increased disability in children with arterial ischemic stroke
Infarct volume and hyperglycemia were associated with increased neurological disability in children with arterial ischemic stroke, according to data published in JAMA Neurology.
In a retrospective study, Kimberly N. Grelli, MD, department of pediatrics, University of Washington, Seattle, and colleagues reviewed the medical records of 98 pediatric patients with arterial ischemic stroke (median age, 6 years; range, 29 days to 18 years; 59.2% boys) admitted to Vanderbilt Children’s Hospital from 2009 to 2013.
Kimberly N. Grelli
Grelli and colleagues analyzed BP, blood glucose, temperature and clinical outcome of all patients. The primary outcome was poor clinical outcome defined as a Pediatric Stroke Outcome Measure score of 1 or greater.
Eleven children (11.2%) died, eight in the hospital and three during follow-up; five of cardiac disease and six of systemic illness. Stroke was not the cause of any death but contributed to a decision to withdraw care for some severely ill children, according to the researchers. Median follow-up for the surviving children was 2.9 months.
The researchers found that 15 of the 98 children were hypertensive at the time of stroke onset. Of the remaining 83 children, 52 (62.7%) became hypertensive during the first 5 days after stroke. Hypertension, however, was not associated with infarct size, poor outcome or mortality.
Sixty-seven (68.4%) of the pediatric patients developed hypotension while at the hospital and 16 (23.9%) received treatment. Hypotension was associated with poor outcome in univariable analysis, but the relationship did not persist in multivariable analysis.
Blood glucose levels, however, affected neurological outcome. Blood glucose levels were available for 94 of 97 patients (96.9%), and of them, 17 (18.1%) had a blood glucose level of 200 mg/dL or greater, which was associated with poor outcome (P = .01). Thirty-seven (37.8%) of the 98 patients also experienced fever, but neither high nor low temperatures were associated with poor outcome.
In addition, Grelli and colleagues observed an association between poor outcome and infarct volume (P < .001). More than 40% (39 patients) had infarct volumes 2% or greater of brain volume; 25.8% (25 patients) had infarct volumes 4% or greater. There was no association between hypertension and size, type or frequency of infarct.
In a multivariable model, poor outcome was strongly associated with an infarct size 4% or greater of brain volume (OR = 5.6; 95% CI, 2-15.4) and a blood glucose level of 200 mg/dL or greater (OR = 3.9; 95% CI, 1.2-12.4).
“Future directions include a prospective analysis of the roles of hypertension, hypotension, blood glucose and fever in children following acute [arterial ischemic stroke],” Grelli and colleagues wrote. “The adult literature supports the role of BP and glucose control after stroke; it is critical to determine the role of this practice in children to help improve outcome.” – by Tracey Romero
Disclosure: The researchers report no relevant financial disclosures.