Predictors of In-Hospital Mortality after Acute Ischemic Stroke in Subjects with and without Diabetes Mellitus

Papazafiropoulou, Athanasia; Sotiropoulos, Alexios; Skliros, Eystathios; Kardara, Marina; Kokolaki, Anthi; Pappas, Stavros

doi:10.2174/1874076600903010034

Cited by 6 publications

(5 citation statements)

References 38 publications

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“…In this study there is mean hyperglycemia of (3.45±1.64) and (4.50±1.05) in those without stress hyperglycemia and this is statistically significant. 13 In the present study, predominantly male patients were affected in all the two groups. Akbar DH et al showed predominance in male among the diabetic and non-diabetic stroke patients and female predominance among the new hyperglycemic stroke patients.…”

Section: Study Resultssupporting

confidence: 46%

Study of Stress Hyperglycemia as a Prognostic Factor in Acute Ischemic Stroke at a Tertiary Care Hospital

Zafar¹,

Malik²,

Aftab³

et al. 2022

PJMHS

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Background: The second most prevalent cause of disability and death worldwide, stroke is silently taking on the characteristics of an epidemic. Almost 85% of the all strokes are ischemic strokes. Objective: To assess the stress hyperglycemia as a prognostic factor in acute ischemic stroke at a tertiary care hospital. Design of the Study: It was a case control study. Place and Duration of Study: This study was conducted at the Department of medicine & Allied Services Hospital Lahore from March 2022 August 2022. Patients and Methods: Total 100 patients with Computerized Tomography (CT) Brain evidence of acute ischemic stroke who met the inclusion criteria were included in the study. At admission, a thorough history was taken and clinical examination was performed. The National Institutes of Health Stroke Scale (NIHSS scale) was used to measure the patient’s neurological state. Fasting Blood sugar (FBS) and Glycosylated Hemoglobin (HBA1c) were performed. Patients' functional recovery was measured by comparing their NIHSS scores on the day of admission and after 7 days in the hospital. Results of the Study: Most of the patients enrolled in our study had age of 61 to 70 years. In study sample 56% of patients were male and 44% were female. Out of 100 patients 56 had stress hyperglycemia and 44 were without stress hyperglycemia. Functional recovery was greater in patients with normoglycemia than in patients with stress hyperglycemia (based on differences in NIHSS score on day one and day seven). The mortality was observed to be 9.2% in patients who had stress hyperglycemia. The mean NIHSS scores was 3.45±1.64 in patients with stress hyperglycemia and 4.50 ± 1.05 was in participants with normoglycemia. Practical Implication: The present study was carried out to know whether stress hyperglycemia can be a prognostic marker in patients of acute ischemic stroke. Conclusion: When compared to patients with stress hyperglycemia, functional recovery was better in patients with normoglycemia. This study demonstrates that patients with normoglycemia had greater functional recovery as compared to patients with stress hyperglycemia, as measured by the difference between the NIHSS scores. As a result, patients with normoglycemia had better outcomes than those with stress hyperglycemia. Keywords: Stress hyperglycemia, Normoglycemia, Acute Ischemic Stroke, Prognostic Factor, NIHSS

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Section: Study Resultssupporting

confidence: 46%

Study of Stress Hyperglycemia as a Prognostic Factor in Acute Ischemic Stroke at a Tertiary Care Hospital

Zafar¹,

Malik²,

Aftab³

et al. 2022

PJMHS

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“…Several clinical and experimental studies have demonstrated that admission hyperglycemia has a deleterious effect on short term outcomes in acute stroke patients though some other studies have debated this [5][6][7]. Acute hyperglycemia in acute stroke is not always due to diabetes mellitus (DM) but may be due to stress response but the exact relationships as a cause or a consequence of more severe stroke remains controversial [8].…”

Section: Introductionmentioning

confidence: 99%

The frequency and impact of admission hyperglycemia on short term outcome of acute stroke patients admitted to Tikur Anbessa teaching hospital, Addis Ababa, Ethiopia

Zewde

Mengesha

Feleke

et al. 2019

Preprint

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Background:- Although acute stroke accompanied by hyperglycemia is often associated with worse prognosis, the relationship between hyperglycemia and stroke outcome has not been studied in Ethiopian patients. As better understanding of this potentially adverse influence on stroke outcome would provide guidance for stroke management and acute care. This study aimed to determine frequency of admission hyperglycemia and its impact on thirty day functional outcome and case fatality among acute stroke patients in an urban setting in Ethiopia. Methods:- From July to December 2016, we collected information on 103 consecutive first ever acute stroke patients admitted within 72 hours of symptom onset to Tertiary hospital in Ethiopia. We obtained demographic, clinical and neuro-imaging data including capillary blood glucose at admission. National Institute of Health Stroke Scale and modified Rankin Scale were used to assess the baseline stroke severity and the degree of disability at thirty day. Results:- A total of 103 first ever acute stroke patients were enrolled with, mean age = 55.5+ 15.3 years, 64.1% male, 65% under the age of 65 years, and 31.1% were farmers by occupation . Fifty one (49.5%) patients had a documented hyperglycemia at admission with median National Institute of Health Stroke Scale score of 14 and 3(2.9%) of them were later diagnosed with diabetes mellitus. The mean modified Rankin score at 30-day was 3.6 + 1.45 while 34 (79.1%) of hyperglycemic stroke survivors scored between 3 and 5. Older age >65 years (p = 0.037), admission hyperglycemia (p = 0.04) and stroke severity (p <0.001) were significantly correlated with poor functional outcome. Conclusions:- High blood glucose on admission was significantly associated with sever disability in acute stroke patients, independent of the presence of diabetes mellitus. By establishing the negative impact of admission hyperglycemia on the neurological outcome, this study suggests that achieving normal blood glucose in the early stages of stroke could have a favorable impact on improved neurological outcome and quality of life for stroke patients. The study provides a rationale for acute stroke management that addresses the potentially adverse consequences of hyperglycemia at the time of presentation in an urban Ethiopian setting.

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“…5, 51.5±4.3 and 45.3±2.1 among the diabetes, new hyperglycemic and non-diabetic stroke patients respectively. Athanasia et al in his study had a higher average age ranges in which the diabetic group had 77.4±6.4 years as compared to 77.3±5.2 years in the non-diabetic stroke group 9. …”

mentioning

confidence: 75%

“…Stress hyperglycemia has been studied in acute myocardial infarction and cerebrovascular event and its outcomes. 9 In spite of vastly available data and recent updates on stroke, there are no clear guidelines to support whether this hyperglycemia needs to be treated or not. Still controversies exist on whether this stress hyperglycemia is harmful and affect the outcome in acute ischemic stroke.…”

mentioning

confidence: 99%

A study of stress hyperglycemia and its relationship with the neurological outcome in patients presenting with acute ischemic stroke

et al. 2016

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Stroke is a common cause of emergency admission which is associated with increased mortality, morbidity and poor quality of life. After coronary artery disease and cancer, stroke is the 3rd most common cause of death in elderly. 1 The outcome of stroke is influenced by various factors including severity, type of stroke, predisposing factors, ABSTRACT Background: Cerebrovascular accident (CVA) continues to be the most common neurological disease in the developed and developing countries. It also stands as the 3rd more common cause of death after cardiovascular disease and cancer. Stroke related burden keeps rising among the patients, their relatives and treating consultants. The neurological outcome depends on various modifiable and non-modifiable risk factors. Among the modifiable risk factors, admission (stress) hyperglycemia has a deleterious effect on the neurological outcome. It is well known by various studies that diabetic patients have more severe outcome and neurological disability after acute stroke than the non-diabetic patients. Now stress hyperglycemia is also becoming a second serious marker to affect the neurological outcome of these stroke patients. The aim was to study the blood sugar level and it`s correlation with the neurological outcome among the acute ischemic stroke patients on admission and at third month of follow-up. Methods: It is a prospective and comparative study done in a tertiary care hospital. Adult patients (> 40 years) presenting with acute ischemic stroke were neurologically stratified based on National Institutes of Health Stroke Scale (NIHSS) and admission blood sugars were noted. They were subdivided into 3 groups. Group 1 consisting of 31 normoglycemic patients, group 2 consisting of 32 stress hyperglycemic patients and group 3 consisting of 40 Type 2 diabetes mellitus (T2DM) patients. They were again reassessed after 3 months with FBS, PPBS and neurological recovery by NHISS. Chi-square test / fischer exact test was used to compare between 3 groups. A p-value of <0.005 was considered statistically significant. Results: The normoglyceamic individuals had much better functional recovery when compared with stress hyperglyceamia and diabetes mellitus groups (p <0.001) at 3 months. Conclusions: Abnormally high blood sugar at the time of presentation in acute stroke patient, significantly alter functional recovery at 3 rd month of follow-up. Hence admission blood sugar level may be used as a surrogate marker to predict functional recovery.

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Predictors of In-Hospital Mortality after Acute Ischemic Stroke in Subjects with and without Diabetes Mellitus

Cited by 6 publications

References 38 publications

Study of Stress Hyperglycemia as a Prognostic Factor in Acute Ischemic Stroke at a Tertiary Care Hospital

Study of Stress Hyperglycemia as a Prognostic Factor in Acute Ischemic Stroke at a Tertiary Care Hospital

The frequency and impact of admission hyperglycemia on short term outcome of acute stroke patients admitted to Tikur Anbessa teaching hospital, Addis Ababa, Ethiopia

A study of stress hyperglycemia and its relationship with the neurological outcome in patients presenting with acute ischemic stroke

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