Influência prognóstica adversa do diabetes mellitus e da hiperglicemia sobre a evolução do infarto cerebral

Abstract

We accessed the potential impact of diabetes mellitus and hyperglycemia on early prognosis in a study of 109 cases of CT proved brain infarction. Main end-points of this study were 30-days case-fatality rates and the probability of early discharge or prolonged hospitalization. Proportions of patients exhibiting diverse evolutions were compared by Fisher's test and, when the number of observations permitted, by chi-square test. Diabetes mellitus was diagnosed by history in 15.6% (17 patients). In 86 cases analysed within 72 hours of admission, hyperglycemia (glucose level higher than 110 mg/dL) was detected in 67.4% (including all 14 diabetic patients (35.3% vs 21.7%; p = 0.18), but these patients probably were discharged early less frequently (23.5% vs 51.1%; p = 0.06). Compared to the normoglycemic patients, hyperglycemic patients also fared worse, when considering altogether the early discharge and case fatality rates and the need for prolonged hospitalization (p = 0.06). They also exhibited a nonsignificant increase in early case fatality rate (31% vs 15.4%; p = 0.21) and a markedly reduced chance of obtaining early hospital discharge (37.9% vs 65.4%; p = 0.03). Case fatality rates were maximal in diabetic hyperglycemic patients (42.9%) and seemed intermediate in non-diabetic hyperglycemic patients (27.3%). Considering the three end-points evaluated, the apparent differences between non-diabetic hyper and normoglycemic patients did not reach statistical significance (p = 0.19). These results suggest that both diabetes mellitus and hyperglycemia "per se" have deleterious effects on the clinical evolution of patients with cerebral infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Ritmo circadiano e doença vascular encefálica: um estudo de correlação com fatores de risco

“…27 .A presença de pacientes com diabetes mellitus no intervalo 6-12 hs reforça a teoria de que a hiperglicemia é fator de risco para a DVE 28 . Os dados obtidos neste trabalho mostram maior frequência de pacientes com DVE no intervalo 6-12 hs, o que está de acordo com a literatura pertinente 24,25,29 , juntamente com a predominância de alguns fatores de risco modificáveis naquele intervalo, os quais podem sofrer interferência do RC.…”

Manejo da hipertensão arterial na isquemia cerebral aguda

“…Por outro lado, a hiperglicemia é potencialmente um fator de pior prognóstico 12,[14][15][16] . O tecido utilizará o excesso de glicose para produzir energia anaerobicamente, levando assim a liberação de ácido láctico e acidose, o que é prejudicial.…”

Adverse prognostic influence of diabetes mellitus and hyperglycemia on the clinical course of brain infarct: a review of its causes with special reference to the pathogenesis of hyperglycemia in the acute phase of stroke

“…Em diversos estudos foi detectada pior evolução clínica, em pacientes com hiperglicemia, após o surgimento de acidentes vasculares encefálicos (AVE) em geral i 0 » 38 , infarto cerebral (IC) 2 » 8 , 27 ou hemorragia cérebro-meníngea 7 . Aumento de gravidade clínica dos AVE na presença de diabetes mellitus (DM) também foi sugerida em diversos estudos, mas de modo ainda não definitivo 2 Experimentalmente, estudos pioneiros, como os de Campbell^ em 1938, e de Craven (citado por Pulsinelli e col. 28 ), em 1950, já sugeriam um efeito protetor de dietas restritivas sobre a gravidade da lesão isquémica cerebral. Na década de 70 surgiram as primeiras experiências controladas demonstrando a associação de hiperglicemia induzida e aumento do déficit neurológico provocado em modelos de isquemia cerebral 24 » 33 .…”