Glycaemic levels as an independent predictor of outcome in acute ischemic stroke from a tertiary care hospital, Nellore, India

Abstract

Background: Stroke is one of the most important causes of long-term disability and the second leading cause of death worldwide. Increasing interest has been focused on the role of hyperglycaemia in the evolution of acute ischaemic stroke because of its risk on stroke outcome and also hyperglycaemia occurs in 30-40% of patients with acute ischaemic stroke; most of these individuals do not have a history of diabetes mellitus.Methods: This study subjects consisted of 100 consecutive patients who presented to the Narayana Medical College and Hospital, Nellore with acute ischaemic stroke within 24 hrs of symptom onset and had capillary blood glucose (CBG) measured on presentation. Patients with hyperglycaemia (CBG>140 mg/dl) were then stratified into those with stress hyperglycaemia, newly detected diabetes mellitus and with pre-existing diabetes mellitus for the purpose of analysis. The outcome of stroke in terms of functional impairment and 90-day mortality were studied.Results: Patients with hyperglycaemia exhibited significantly greater functional impairment (p<0.0001) than those with normoglycemia. The outcome was poor in patients with hyperglycaemia. Stroke severity (p<0.001) and functional impairment (p<0.001) were both significantly worse in patients with Hyperglycaemia and no prior history of DM; when compared to a patient with hyperglycaemia and previously diagnosed DM.Conclusions: This study concludes that hyperglycaemia at stroke onset is associated with a higher risk of poor outcome independent of the other variables. Patients with hyperglycaemia at stroke onset, without prior history of DM, have a particularly poor prognosis, then that of patients with known diabetes. Thus, hyperglycaemia is not solely a stress response to neurological insult, as it predicts outcome. Hence, hyperglycaemia needs to be treated to have reduced morbidity and mortality pertaining to stroke outcome.