The frequency and impact of admission hyperglycemia on short term outcome of acute stroke patients admitted to Tikur Anbessa Specialized hospital, Addis Ababa, Ethiopia: a cross-sectional study

Abstract

BackgroundAdmission hyperglycemia (HG) has been associated with worse outcomes among acute stroke patients. A better understanding and awareness of the potentially adverse influence of hyperglycemia on the clinical outcome of acute stroke patients would help to provide guidance for acute stroke management and prevention of its adverse outcomes. We aimed to assess the frequency of admission hyperglycemia and its impact on short term (30-days) morbidity and mortality outcomes of stroke in adult Ethiopian patients in an urban setting.MethodsA prospective, cross-sectional study was conducted among acute stroke patients admitted to Tikur Anbessa Specialized Hospital (TASH), within 72 h of symptom onset, from July to December 2016. Socio-demographic data, neuroimaging findings and capillary blood glucose values were obtained on admission. Hyperglycemia was defined as > 140 mg/dl. National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to assess the baseline stroke severity and the 30-days post-stroke outcome, respectively.ResultsA total of 103 first-ever acute stroke patients were included (mean age = 55.5 + 15.3 years, 64.1% male and 65% under the age of 65 years) and 51 (49.5%) were hyperglycemic at time of admission. The median admission NIHSS score was worse in the hyperglycemic patients 14 (IQR 10–19) compared to normoglycemic patients 11 (IQR 8–15). Among stroke survivors, patients with hyperglycemia were 3.83 times (95% CI, 1.99–6.19) more likely to be functionally impaired (mRS = 3–5) at 30-days compared to normoglycemic patients (P = 0.041).Older age (≥ 65 years) (P = 0.017) and stroke severity (NIHSS > 14) (P = 0.006) at admission were both significantly associated with poor functional recovery at 30-day. Among patients who died at 30-day, two-third (66.7%) were hyperglycemic but they failed to show any significant association.ConclusionsHyperglycemia is prevalent among Ethiopian stroke patients at the time of presentation and it is associated with significantly poor functional recovery at 30th-day of follow up. This finding provides a rationale for achieving normal blood glucose in the course of acute stroke management which could have a favorable impact on the neurological outcome and quality of life for patients.

Magnitude and predictors of post-stroke cognitive impairment among Ethiopian stroke survivors: A facility-based cross-sectional study

“…Although stroke risk increases with age, the average age of stroke survivors in our cohort was 52 years and more than one-third had stroke at a younger age, which is defined as stroke occurrence before the age of 45 years. This result is in agreement with our prior study in the same setting ( 23 ). However, most other regional and global studies reported a relatively higher age for stroke related cognitive impairment ( 9 , 10 , 18 , 20 ).…”

Persistent hyperglycemia is a useful glycemic pattern to predict stroke mortality: a systematic review and meta-analysis

“…Over 50% of patients within each stroke subtype had glucose levels greater than 6.0 mmol/l on admission [ 22 ]. Post-stroke hyperglycemia not only worsens functional outcomes and vascular perfusion [ 23 ], but also leads to spontaneous intracerebral hemorrhage, impaired executive functions [ 24 ], and death [ 25 ] in stroke patients, especially in patients with large vessel occlusion [ 26 , 27 ]. Blood glucose levels seem to decline within the first 24 h after stroke onset [ 28 ], but they rise again after approximately 24–88 h, regardless of the presence of DM [ 29 , 30 ].…”

Effects of Hyperferritinemia on Functional Outcome in Acute Ischemic Stroke Patients with Admission Hyperglycemia

“…Hyperferritinemia was independently associated with poor 3-month outcome in patients with hyperglycemia but not in those without. Considering multiple definitions of admission hyperglycemia among studies, we performed a sensitivity analysis and found similar associations between hyperferritinemia and poor 3-month outcome in patients with hyperglycemia, defined as blood glucose ≥126 mg/dL [33], 130 mg/dL [7, 34], or 140 mg/dL [6, 35].…”

“…Despite a decreased case fatality and improved functional outcome of acute ischemic stroke (AIS) [2], cost attributed to continuing post-stroke functional rehabilitation, homecare, lost productivity adds up to around Wu $106,000 calculated as mean cost per person [3], bringing a substantial economic and social burden. Admission hyperglycemia quite commonly accompanies AIS patients, which have a relationship with unfavorable clinical outcomes [4][5][6][7]. Therefore, it is necessary to investigate key factors associated with poor outcome in ischemic stroke patients and those with admission hyperglycemia especially.…”