Adam de Havenon1, Varsha Muddasani2, Marissa Castillo3, Kevin N Sheth4, Alen Delic2, Ali Herman5, Mark Conaway6, Karen C Johnston7. 1. Department of Neurology, University of Utah, Salt Lake City, Utah, United States. Electronic address: adam.dehavenon@hsc.utah.edu. 2. Department of Neurology, University of Utah, Salt Lake City, Utah, United States. 3. Department of Public Health Sciences. Electronic address: MCastillo@sa.utah.edu. 4. Department of Neurology, Yale University, New Haven, Connecticut, United States. Electronic address: kevin.sheth@yale.edu. 5. Department of Neurology, Yale University, New Haven, Connecticut, United States. Electronic address: ali.herman@yale.edu. 6. Department of Public Health Sciences. Electronic address: mrc6j@virginia.edu. 7. Department of Public Health Sciences; Department of Neurology, University of Virginia, Charlottesville, Virginia, United States. Electronic address: KJ4V@hscmail.mcc.virginia.edu.
Abstract
BACKGROUND: Hyperglycemia is common after acute ischemic stroke and is associated with worse outcome, but intensive glucose control has not improved outcome. There is also a racial disparity in outcome after stroke, with Black patients more likely to have functional impairment than whites. We aimed to evaluate if there were racial differences in outcomes in acute ischemic stroke patients treated with intensive glucose control. METHODS: We performed a post-hoc analysis of the Stroke Hyperglycemia Insulin Network Effort (SHINE) trial to determine if Black patients had worse functional outcome than whites and if standard versus intensive glucose control modified that association. We included non-Hispanic white and Black patients. The primary outcome was excellent functional outcome (90-day modified Rankin Score of 0-1). To account for patient clustering by study site, we fit mixed-effects logistic regression models to our outcome and tested the interaction of treatment and race. RESULTS: We included 895 patients, of which 304 (34%) were Black and 591 (66%) were white. The rate of excellent outcome was 31.6% in Black patients versus 41.0% in white patients (p=0.006). After adjusting for potential confounders, the odds ratio for excellent outcome in Black patients was 0.54 (95% CI 0.38-0.77). The interaction term between treatment and race was significant (p=0.067). In the intensive treatment arm, Black patients had a predicted probability of excellent outcome of 26.4% (20.1-32.8) versus 42.7% (37.6-47.9) for white patients (p<0.001), while in the standard treatment arm the difference was not significant. CONCLUSIONS: Black patients with acute ischemic stroke and hyperglycemia had worse functional outcome at 90 days than white patients, particularly if given intensive glucose control. These findings are from a post-hoc analysis and may be confounded, thus warrant additional study.
BACKGROUND: Hyperglycemia is common after acute ischemic stroke and is associated with worse outcome, but intensive glucose control has not improved outcome. There is also a racial disparity in outcome after stroke, with Black patients more likely to have functional impairment than whites. We aimed to evaluate if there were racial differences in outcomes in acute ischemic stroke patients treated with intensive glucose control. METHODS: We performed a post-hoc analysis of the Stroke Hyperglycemia Insulin Network Effort (SHINE) trial to determine if Black patients had worse functional outcome than whites and if standard versus intensive glucose control modified that association. We included non-Hispanic white and Black patients. The primary outcome was excellent functional outcome (90-day modified Rankin Score of 0-1). To account for patient clustering by study site, we fit mixed-effects logistic regression models to our outcome and tested the interaction of treatment and race. RESULTS: We included 895 patients, of which 304 (34%) were Black and 591 (66%) were white. The rate of excellent outcome was 31.6% in Black patients versus 41.0% in white patients (p=0.006). After adjusting for potential confounders, the odds ratio for excellent outcome in Black patients was 0.54 (95% CI 0.38-0.77). The interaction term between treatment and race was significant (p=0.067). In the intensive treatment arm, Black patients had a predicted probability of excellent outcome of 26.4% (20.1-32.8) versus 42.7% (37.6-47.9) for white patients (p<0.001), while in the standard treatment arm the difference was not significant. CONCLUSIONS: Black patients with acute ischemic stroke and hyperglycemia had worse functional outcome at 90 days than white patients, particularly if given intensive glucose control. These findings are from a post-hoc analysis and may be confounded, thus warrant additional study.
Authors: James F Burke; Vicki A Freedman; Lynda D Lisabeth; Devin L Brown; Adrianne Haggins; Lesli E Skolarus Journal: Neurology Date: 2014-06-27 Impact factor: 9.910
Authors: Karen C Johnston; Askiel Bruno; Qi Pauls; Christiana E Hall; Kevin M Barrett; William Barsan; Amy Fansler; Katrina Van de Bruinhorst; Scott Janis; Valerie L Durkalski-Mauldin Journal: JAMA Date: 2019-07-23 Impact factor: 56.272
Authors: L S Williams; J Rotich; R Qi; N Fineberg; A Espay; A Bruno; S E Fineberg; W R Tierney Journal: Neurology Date: 2002-07-09 Impact factor: 9.910