Dynamic of Glycemic State as a Prognostic Marker in Acute Ischemic Stroke: A Prospective Controlled Cohort Observational Study

Abstract

Abstract Background Hyperglycemia is encountered in 20% to 40% of acute stroke patients, with or without a pre-morbid diagnosis of diabetes mellitus. Hyperglycemia is a risk factor for infarct expansion and poor outcome through the first 72 hours of hospitalization in both diabetics and nondiabetics. Major and minor studies of stroke patients suggested that ‘Stress Hyperglycemia’ (raised blood glucose levels without a previous diagnosis of diabetes) was associated with a poorer outcome. Aim of the Work The aim of the work was to study the glycemic status after acute ischemic stroke and to assess the influence of glycemic status in the stroke outcome. Patients and Methods This study was a prospective cohort study conducted in Ain shams University Hospitals during the period from October 2019 to March 2020. The study included a total of 105 patients presented with acute ischemic stroke within 24 hours from onset of symptoms. The study population were predominantly males (60.95%), with a mean age of 61.66 ± 10.38 years (range from 40 to 85 years). Results Our study revealed that: Hyperglycemia is a good predictor of mortality outcome after acute ischemic stroke (65.7% vs. 5.7%), stress hyperglycemia had the worst mortality outcome compared with diabetic group and control group (85.7% vs. 45.7% vs. 5.7%; respectively), hyperglycemia is a good marker of stroke severity assessed by NIHSS score (14.60 ± 5.80 vs. 7.60 ± 3.38), hyperglycemia has significant association with longer ICU and hospital stay (12.26 ± 8.92 vs. 2.89 ± 4.07 days), NIHSS score is a significant predictor of mortality outcome after acute stroke (18.20 ± 3.43 vs. 7.30 ± 1.86), hyperglycemia has significant association with posterior circulation strokes (20% vs. 0.0%) and patients with hyperglycemia had higher incidence of intracerebral complications, namely hemorrhagic transformation (17.1%) and brain edema (10%). Conclusion This study revealed that there is an association between admission hyperglycemia and poor outcome after acute ischemic stroke. Admission hyperglycemia worsens the outcome and functional disability during the phase of ischemic stroke. Hyperglycemia at stroke onset, without prior history of DM have particularly poor prognosis, than those with hyperglycemia in known diabetes.