Glycemic Control of Stroke Patients and Their Outcomes in a Comprehensive Stroke Center at a Tertiary Care Hospital: A Retrospective Cohort

Abstract

Background: Diabetes mellitus is one of the major modifiable risk factors for having a stroke and those who present with a stroke are found to have hyperglycemia. The association between hyperglycemia and stroke has been found in an increasing number of studies. Evidence indicates that persistent in-hospital hyperglycemia during the first 24 hours after acute ischemic stroke (AIS) is associated with worse outcomes than normoglycemia. We conducted a retrospective chart review to see the glycemic control of stroke patients and their hospital outcome over a 3-month period as part of a pre-evaluation assessment to develop a hyperglycemia protocol in the stroke unit. Methods: Institutional review board approval was obtained for this study. A total of 142 patients with acute stroke admitted in the Comprehensive Stroke Center at Jersey Shore University Medical Center over a 3-month period were included in this study. Demographic characteristics, comorbidities, glycemic patterns at admission and throughout the hospital stay, types of stroke, length of stay, NIH (National Institutes of Health) stroke scale on admission and discharge, discharge disposition and outcome were reviewed retrospectively. Statistical analysis was performed by SPSS and a nova with tukey as post-hoc analysis. For the graph, we used prism and for the regression analysis, stat disk was used. Results: Average age of the patients was 73 years, with male predominance (54%). Average BMI of the patients was 28.2. Most of the patients had an ischemic stroke (73%). Major comorbidities were hypertension (88%), dyslipidemia (66%), and diabetes (36%). About 8 of 143 (6%) patients were newly diagnosed with diabetes. Average Hba1C was 6.5. For a detailed statistical analysis, we divided patients into three groups by their blood glucose levels ranging from 80-140 mg/dl in group 1, 140-180 mg/dl in group 2, and more than 180 mg /dl in group 3. Then, we compared the length of stay (LOS), NIH scale admission/discharge, types of stroke and discharge disposition within the three groups. This study showed that the NIH stroke scale on admission in group 3 (blood glucose >180mg/dl) was higher compared to group 1 (blood glucose 80-140 mg/dl), with a p value of <0.01. Length of stay was more in group 3 compared to group 1 and 2, with a P value < 0.08. Conclusion: Although this study limited by smaller patient groups, but it concludes that higher blood glucose level associated with higher NIH stroke scale at admission and during discharge and have increased length of stay which is consistent with other similar studies.