Influence of Hyperglycemia Associated with Enteral Nutrition on Mortality in Patients with Stroke

Abstract

Objectives: To evaluate in patients admitted for stroke: (1) The frequency of hyperglycaemia associated with enteral nutrition (EN). (2) The risk of morbidity and mortality associated with the development of this type of hyperglycaemia. Methods: A longitudinal observational study was conducted in 115 non-diabetic patients admitted for stroke with EN. Age, functional capacity (Rankin scale), and blood plasma glucose (BPG) were recorded. Hyperglycaemia was considered as: a value higher than 126 mg/dL before the EN and/or a value higher than 150 mg/dL after a week of enteral nutrition. According to this, three groups were differentiated: HyperES: Those who had hyperglycemia before the beginning of the EN (33% patients); NoHyper: those who did not have hyperglycemia before or after (47.8% patients); and HyperEN: Those who did not have hyperglycemia before but suffered it after the beginning of the EN (19.1% patients). Results: The age was 72.72 (15.32) years. A higher rate of mortality was observed in the HyperEN group 45.50%, than HyperES 15.80% or NoHyper: 10.90%). A lower recovery of the oral feeding was observed in those patients of the HyperEN group 27.30%, than HyperES: 42.10% or NoHyper: 61.80%). In the multivariate analysis adjusting for age, sex, and Rankin scale the development of hyperglycemia in those who did not have it at the beginning (HyperEN) was an independent risk factor for non-recovery of the oral feeding (OR: 4.21 (1.20–14.79), p = 0.02); and mortality adjusted for age, sex and Rankin scale (OR: 6.83 (1.76–26.47), p < 0.01). Conclusions: In non-diabetic patients admitted for stroke with EN, the development of hyperglycaemia in relation to enteral nutrition supposes an independent risk factor for mortality and for the non-recovery of the oral feeding.

Effect of a diabetes-specific formula in non-diabetic inpatients with stroke: a randomized controlled trial

“…In patients with complete enteral nutrition, the incidence of hyperglycaemia can reach 30% [12]. In a previous study in 158 non-diabetic patients admitted by stroke in our hospital, 33% (52 patients) of non-diabetic patients with stroke and complete enteral nutrition developed stress hyperglycaemia and 19.1% (30 patients) developed hyperglycaemia related to the use of enteral nutrition [13].…”

A UK national survey of enteral feed use in people with diabetes 2022

“…This is significant as poor glucose control is associated with poor outcomes for a number of diseases including stroke -both hyper and hypoglycaemia are considered detrimental. [2][3][4][5][6][7][8][9][10][11] A variety of hospitals responded to the request for information about the management of enteral feeding. This was a small proportion of the total number of hospitals in the UK and is likely to represent units that have more of an interest in this problem.…”

“…As these people are receiving feeds for prolonged periods this is potentially many days of poor glucose control. This is significant as poor glucose control is associated with poor outcomes for a number of diseases including stroke – both hyper and hypoglycaemia are considered detrimental 2–11 …”

Plasma creatine kinase and all-cause mortality in patients on peritoneal dialysis: a multi-center retrospective study

“…Although the lowest Quartile of CK (< 60 U/L) was associated with a lower risk of all-cause death, the mean hemoglobin and albumin levels in the Quartile 1 were significantly lower than those in the Quartile 4. It is well known that lower hemoglobin and albumin, as markers of malnutrition, are associated with a higher risk of all-cause mortality [18]. Additionally, lower plasma CK may be considered a marker of malnutrition and relatively low muscle mass, which has been linked to a higher risk of all-cause mortality [17,19].…”