Abstract 43: Predicting Clinical Outcomes After Thrombolysis in Patients with Diabetes in Acute Ischemic Stroke

Background: Diabetes is a well-known stroke risk factor that is associated with poorer stroke outcomes. Limited tools are available to evaluate clinical outcomes and response to thrombolysis in stroke patients with Diabetes. Methods: We applied the iScore (www.sorcan.ca/iscore), a validated risk score, to stroke patients presenting to stroke centers participating in the Registry of the Canadian Stroke network (RCSN). Outcome measures: Favorable outcome (defined as a modified Rankin scale 0-2) at discharge after thrombolysis. Secondary outcomes included intracerebral hemorrhage, death at 30-days and at 1-year stratified by tertiles of the iScore. Results: Among 12,686 patients with an acute ischemic stroke, 3,228 (25.5%) had diabetes. Patients with diabetes had higher likelihood of death or disability (mRS>3) at discharge after thrombolysis compared to patients without diabetes (75.7% vs. 68.9%; RR 1.01 95%CI 1.02-1.18). The risk of intracranial hemorrhage (any type or symptomatic) was not different in patients with or without diabetes (12.6% vs. 12.5%; RR 1.01, 95%CI 0.72-1.4 and 7.5% vs 6.8%; RR 1.11, 95% CI 0.7-1.72 respectively). In the logistic regression analysis, there was an interaction between tPA and the iScore (p<0.001), but there was no interaction between diabetes and the iScore or tPA. Conclusion: Stroke patients with diabetes had higher mortality. The iScore similarly predicted a clinical response after tPA in both patients with and without diabetes. ICH was similar in both groups.