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

Abstract

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.

Prognostic value of glucose fluctuation in patients undergoing thrombolysis or thrombectomy due to acute ischemic stroke

“…The glucose value of normoglycemic patients was 119.9 ± 13.0 mg/dl and that of hyperglycemic patients was 183.2 ± 34.5 mg/dl. Mean NIHSS was 14 in hyperglycemic patients and 11 in normoglycemic patients, while the risk of poor prognosis was 3.83 times higher in hyperglycemic patients (p = 0.041) [18]. As a result these two studies also supports our hypothesis.…”

Frequency and predictors of post-stroke cognitive impairment in Ethiopian stroke survivors: A 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 in the young, which is de ned 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).…”

Frequency of Undiagnosed Diabetes Mellitus in Patients Presenting with Acute Stroke in a Medical Emergency

“…5 Greater knowledge of how hyperglycemia may negatively affect the outcome of individual patients with acute stroke might help to direct the treatment of acute stroke and the avoidance of its negative effects. 6 According to observational epidemiology, diabetes poses a risk for all phases of the stroke process, from accidental cerebrovascular illness discovered during neuroimaging through an incident acute stroke and its longer-term recovery. Patients who had previously undiagnosed DM or non-DM are routinely not examined for RBS levels, which may have negative outcomes for strokes worsened by hyperglycemia at the time of stroke and also deteriorate the cerebrovascular system.…”