Predicting clinical outcomes and response to thrombolysis in acute stroke patients with diabetes

Objective — Few tools are available to evaluate clinical outcomes and response to thrombolysis (tPA) in stroke patients with diabetes. The researchers explored how the iScore (www.sorcan.ca/iscore), a validated risk score, predicts clinical outcomes in stroke patients with and without diabetes

Research Design and Methods — The researchers applied the iScore to stroke patients presenting to stroke centers participating in the Registry of the Canadian Stroke network. Main outcomes included favorable outcome, defined as a modified Rankin scale (mRS) 0-2 at discharge, and intracerebral hemorrhage (ICH) after tPA.

Results — Among 12,686 patients with an acute ischemic stroke, 3,228 (25.5%) had diabetes. Among patients receiving tPA (n = 1,689), those with diabetes had a lower rate of a favorable outcome compared with their counterparts (24.3 vs. 31.1%; RR 0.90 [95% CI 0.82-0.98]). The risk of ICH was not significantly different in patients with or without diabetes (for any type 12.6 vs. 12.5%. RR 1.01 [0.72-1.40]; for symptomatic ICH 7.5 vs. 6.8%, RR 1.11 [0.70-1.72]). The regression analysis revealed a decline in the probability of a favorable outcome after tPA with increments in the iScore (P value for iScore × tPA interaction <0.001). There was no difference in the response to tPA predicted by the iScore between stroke patients with and without diabetes (P value = 0.07).

Conclusions — Stroke patients with diabetes have poorer outcomes compared with patients without diabetes, which is not explained by ICH. The iScore similarly predicts response to tPA between stroke patients with and without diabetes.