Impact of hyperglycemia on ischemic stroke mortality in diabetic and non-diabetic patients

Abstract

BACKGROUNDPrevious studies suggest that infarct expansion may be responsible for increased mortality after stroke onset in patients with prolonged stress hyperglycemia. Therefore, we evaluated the influence of prolonged stress hyperglycemia on stroke mortality in patients with and without diabetes.PATIENTS AND METHODSFor 630 stroke patients admitted to the neurological intensive care department within 24 hours of stroke onset, we correlated mean blood glucose levels (MBGL) at admission and 72 hours after admission in diabetic and non-diabetic patients with final outcome. Blood glucose levels higher then 6.1 mmol/L (121 mg/dL) were treated as hyperglycemia.RESULTSOf 630 patients (mean age 71 ± 6), 410 were non-diabetic (mortality, 25%) and 220 patients were diabetic (mortality, 20%). All patients who died within 28 days of hospitalization had prolonged hyperglycemia (at admission and after 72 hours, despite insulin therapy). The unadjusted relative risk of in-hospital mortality within 28 days for all stroke patients was 0.68 (95% CI, 0.14–1.9) for non-diabetic patients and 0.39 (95% CI, 0.27–1.56) for diabetic patients. The unadjusted relative risk of in-hospital mortality within 28 days in ischemic stroke in patients with MBGL > 6.1–8.0 mmol/L (121–144 mg/dL) at admission and after 72 hours was 1.83 (95% CI, 0.41–5.5) for non-diabetic patients and 1.13 (95% CI, 0.78–4.5) for diabetic patients. Non-diabetic patients with hyperglycemia had a 1.7 times higher relative risk of in-hospital 28-day mortality than patients with diabetes.CONCLUSIONProlonged stress hyperglycemia in ischemic stroke patients increases the risk of in-hospital 28-day mortality, especially in non-diabetic patients.

Kidney Disease Is a Negative Predictor of 30-Day Survival after Acute Ischaemic Stroke

“…An independent predictor remaining was only the actual glucose level. It seems to confirm that in AIS, ‘stress’ hyperglycaemia is an important negative predictor of short-term mortality [35], although it should be mentioned that this effect is much stronger in non-diabetic patients.…”

Severe instead of mild hyperglycemia inhibits neurogenesis in the subventricular zone of adult rats after transient focal cerebral ischemia

“…Over the past decades, clinical observational and epidemiologic studies show that post-stroke hyperglycemia is independently connected with higher mortality, poorer functional recovery (Capes et al, 2001;Kes et al, 2007;Dave et al, 2010) as well as brain infarct expansion, identified by Magnetic resonance imaging (MRI) (Capes et al, 2001;Parsons et al, 2002), especially in non-diabetic patients. Nevertheless, a randomized, placebo-controlled glucose potassium insulin (GKI) infusion trial has achieved a normalized blood glucose level in patients with admission glucose >126 mg/dl (7 mM) within 24 h of ischemic stroke, yet failed to attenuate infarct volume (McCormick et al, 2010).…”

Persistent Hyperglycemia at 24–48 h in Acute Hyperglycemic Stroke Patients Is Not Associated with a Worse Functional Outcome

“…Similarly, it was shown that prolonged stress hyperglycemia increases mortality in ischemic stroke patients, an effect which was more pronounced in nondiabetics compared to diabetics [21]. It has been shown as well that intravenous thrombolysis attenuates infarct growth in nondiabetics but not in diabetics [22].…”