Abstract
BackgroundTo compare the characteristics and prognostic features of ischemic stroke in patients with diabetes and without diabetes, and to determine the independent predictors of in-hospital mortality in people with diabetes and ischemic stroke.MethodsDiabetes was diagnosed in 393 (21.3%) of 1,840 consecutive patients with cerebral infarction included in a prospective stroke registry over a 12-year period. Demographic characteristics, cardiovascular risk factors, clinical events, stroke subtypes, neuroimaging data, and outcome in ischemic stroke patients with and without diabetes were compared. Predictors of in-hospital mortality in diabetic patients with ischemic stroke were assessed by multivariate analysis.ResultsPeople with diabetes compared to people without diabetes presented more frequently atherothrombotic stroke (41.2% vs 27%) and lacunar infarction (35.1% vs 23.9%) (P < 0.01). The in-hospital mortality in ischemic stroke patients with diabetes was 12.5% and 14.6% in those without (P = NS). Ischemic heart disease, hyperlipidemia, subacute onset, 85 years old or more, atherothrombotic and lacunar infarcts, and thalamic topography were independently associated with ischemic stroke in patients with diabetes, whereas predictors of in-hospital mortality included the patient's age, decreased consciousness, chronic nephropathy, congestive heart failure and atrial fibrillationConclusionIschemic stroke in people with diabetes showed a different clinical pattern from those without diabetes, with atherothrombotic stroke and lacunar infarcts being more frequent. Clinical factors indicative of the severity of ischemic stroke available at onset have a predominant influence upon in-hospital mortality and may help clinicians to assess prognosis more accurately.
Highlights
To compare the characteristics and prognostic features of ischemic stroke in patients with diabetes and without diabetes, and to determine the independent predictors of inhospital mortality in people with diabetes and ischemic stroke
To improve our knowledge of ischemic stroke in diabetes, we carried out a clinical study of patients with diabetes and cerebral infarction collected from an hospital-based stroke registry with the following objectives: 1) to compare demographic data, clinical variables, stroke subtypes, and prognostic features of ischemic stroke in patients with diabetes and without diabetes; and 2) to determine the independent predictors of in-hospital mortality in people with diabetes and ischemic stroke
Of in-hospital mortality for the group of non-diabetic stroke patients. In this hospital-based study of 1,840 consecutive patients with acute ischemic stroke, the prevalence of diabetes was 21%, a figure similar to that reported in the studies of Megherbi et al [22] and Jorgensen et al [4] and higher than the prevalence of diabetes in the Spanish population (6–7%) [23]. This may be explained by a stronger disposition to stroke in the diabetic patient, because diabetes mellitus is associated with accelerated atherogenesis [24] and due to the fact that diabetic stroke patients have more often other cerebrovascular risk factors as, in our study, hyperlipidemia and ischemic heart disease, which in turn were independent predictors of ischemic stroke in the diabetic population as previously reported by others [25,26]
Summary
To compare the characteristics and prognostic features of ischemic stroke in patients with diabetes and without diabetes, and to determine the independent predictors of inhospital mortality in people with diabetes and ischemic stroke. Diabetes is the cerebrovascular risk factor associated with greater in-hospital mortality both in patients with ischemic stroke [2,3,4,5] and intracerebral hemorrhage [6]. To improve our knowledge of ischemic stroke in diabetes, we carried out a clinical study of patients with diabetes and cerebral infarction collected from an hospital-based stroke registry with the following objectives: 1) to compare demographic data, clinical variables, stroke subtypes, and prognostic features of ischemic stroke in patients with diabetes and without diabetes; and 2) to determine the independent predictors of in-hospital mortality in people with diabetes and ischemic stroke
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