Abstract
Introduction: Hyperglycemia is common in the early phase of stroke. The present study was aimed to assess the effect of stress hyperglycemia on the functional outcome in patients with ischemic stroke patients admitted to our indoor wards.
Methodology: This prospective study was conducted in the Department of Medicine, DY Patil School of Medicine, Navi Mumbai from June 2017 till June 2018 of patients who were admitted with the diagnosis of ischemic stroke. Stress hyperglemia was defined as fasting serum glucose levels at the first day after admission ≥126 mg/dl in patients without diabetes mellitus. Information regarding the demography, anthropometry, risk factors and blood sugar were noted. The severity of stroke was assessed with the National Institutes of Health Stroke Scale (NIHSS) and clinical outcome was assessed using the modified Rankin scale (mRS) at discharge.
Results: During the study period, a total of 106 patients were included and were classified as normoglycemic, stress hyperglycemic and diabetic. The mean age and gender distribution of the patients in all the three groups was similar. After 3 months, the NIHSS was significantly higher among patients with stress hyperglycemia as compared to those with normoglycemia. Further, asignificantly higher proportion of patients with stress hyperglycemia had a poor outcome (according to mRS) as compared to normoglycemics and similar to those with diabetics.
Conclusions: Ischemic stroke patients with stress hyperglycemia had worse clinical and functional outcome over a short-term follow up period. at 3rd month of follow-up.
Keywords: Stress hyperglycemia; Diabetes mellitus; Ischemic stroke; Outcome.
References
- Scott JF, Robinson GM, French JM, O'connell JE, Alberti KG, Gray CS. Prevalence of admission hyperglycaemia across clinical subtypes of acute stroke. The Lancet. 1999 Jan 30;353(9150):376-7..
- Bruno A, Biller J, Adams HP Jr, et al. Acute blood glucose level and outcome from ischemic stroke. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. Neurology 1999;52:280 –284.
- Counsell C, McDowall M, Dennis M. Hyperglycaemia after acute stroke. Other models find that hyperglycaemia is not in- dependent predictor. BMJ 1997;315:810–811.
- Bravata DM, Kim N, Concato J, Brass LM. Hyperglycaemia in patients with acute ischaemic stroke: how often do we screen for undiagnosed diabetes?. Qjm. 2003 Jul 1;96(7):491-7.
- Sarkar RN, Banerjee S, Basu A. Comparative evaluation of diabetic and non-diabetic stroke –Effect of glycemia on outcome. J Indian Med Assoc 2004;102(10): 551-53.
- Parsons MW, Barber PA, Desmond PM, Baird TA, Darby DG, Byrnes G, Tress BM, Davis SM. Acute hyperglycemia adversely affects stroke outcome: a magnetic resonance imaging and spectroscopy study. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society. 2002 Jul;52(1):20-8.
- Pulsinelli WA, Waldman S, Rawlinson D, Plum F. Moderate hyperglycaemia augments ischaemic brain damage: a neuro- pathologic study in the rat. Neurology 1982;32:1239–1246.
- Anderson RE, Tan WK, Martin HS, Meyer FB. Effects of glu- cose and PaO2 modulation on cortical intracellular acidosis, NADH redox state, and infarction in the ischemic penumbra. Stroke 1999;30:160–170.
- Stead LG, Gilmore RM, Bellolio MF, Mishra S, Bhagra A, Vaidyanathan L, et al. Hyperglycemia as an independent predictor of worse outcome in non-diabetic patients pre- senting with acute ischemic stroke. Neurocrit Care 2009;10: 181–6.
- Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke 2001;32: 2426–32.
- Szczudlik A, Slowik A, Turaj W, Wyrwicz-Petkow U, Pera J, Dziedzic T, et al. Transient hyperglycemia in ischemic stroke patients. J Neurol Sci 2001;189:105–11
Corresponding Author
Dr Sweta Jadav
Department of General Medicine, DY Patil University,
School of Medicine, Nerul, Navi Mumbai-400706, India
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i11.111
