Admission Random Blood Glucose Research Articles

Relationship between admission random blood glucose, fasting blood glucose, with severity of coronary lesion and hospital outcomes in patients admitted with ST elevation myocardial infarction

Background: This research addressed the relationships between admission random blood glucose (RBG), fasting blood glucose (FBG), and severity of coronary artery disease (CAD) “assessed by Gensini score “and in hospital outcomes in patient admitted with ST elevated Myocardial Infarction (STEMI). Methods: The research was conducted on 100 cases who were recruited from Cardiology department in Tanta University presented with STEMI and underwent coronary angiography either primary PCI or Pharmaco-invasive, the cases were categorized firstly, according to RBG into two groups: Group 1: Non hyperglycemia group (200 mg/dl). Then after 8hours from admission FBG was tested "regarding FBG Patient is fasting but to be well hydrated" and accordingly the cases were further sub-divided into two groups: Group I: Non-FBG elevated (126 mg/dl). Results: It was shown that there was a significant difference between the hyperglycemic and FBG elevated groups in terms of severity of CAD and In-hospital mortality where both the hyperglycemic and the FBG elevated cases had more extensive CAD and higher Gensini score. Also, the occurrence of major adverse cardiovascular events was higher in these two groups in comparison to their non-hyperglycemic, non FBG elevated counterparts. There was statistically significant positive correlation between Gensini score and RBS and fasting blood glucose level (p

The significance of glycated haemoglobin, randomized admission blood glucose, and fasting blood glucose on in-hospital adverse cardiac events in patients with ST-elevation acute myocardial infarction

In an ST-segment elevation acute myocardial infarction (STEMI), glucose metabolism undergoes disturbance secondary to acute myocardial injury, which affects the clinical outcome during the acute phase. Glucose metabolic disturbance indices are glycated haemoglobin, admission random glucose, and fasting glucose in blood circulation during STEMI. This is a retrospective cohort study, aimed to investigate whether glycated haemoglobin, admission random blood glucose, and fasting blood glucose levels are the risk factors for developing in-hospital adverse cardiac events in STEMI. The result showed that among the three glucose metabolic disturbance indices, fasting glucose was an independent predictor (adjusted OR: 1.010 (95% CI: 1.001-1.018) and the most accurate factor (AUC 64.9 %) for adverse cardiac events. Other glucose metabolic indices, namely random blood glucose and glycated haemoglobin, were associated with increased odds to develop adverse cardiac events but they did not independently predict adverse cardiac events. Therefore, fasting blood glucose was an independent predictor and the most accurate factor for adverse cardiac events in the acute event of STEMI.

Admission Random Blood Glucose, Fasting Blood Glucose, Stress Hyperglycemia Ratio, and Functional Outcomes in Patients With Acute Ischemic Stroke Treated With Intravenous Thrombolysis.

BackgroundStress hyperglycemia ratio (SHR), calculated as glucose/glycated hemoglobin, has recently been developed for assessing stress hyperglycemia and could provide prognostic information for various diseases. However, calculating SHR using random blood glucose (RBG) drawn on admission or fasting blood glucose (FBG) could lead to different results. This study intends to evaluate the association between SHR and functional outcomes in patients with acute ischemic stroke (AIS) with recombinant tissue plasminogen activator (r-tPA) intravenous thrombolysis.MethodsData from 230 patients with AIS following thrombolytic therapy with r-tPA in the Third Affiliated Hospital of Wenzhou Medical University from April 2016 to April 2019 were retrospectively reviewed. SHR1 was defined as [RBG (mmol/L)]/[HbA1c (%)] and SHR2 was defined as [FBG (mmol/L)]/[HbA1c (%)]. The outcomes included early neurological improvement (ENI), poor function defined as a modified Rankin Scale score (mRS) of 3–6, and all-cause death in 3 months. Multivariable logistic regression was performed to estimate the association between SHR and adverse outcomes.ResultsAfter adjustment for possible confounders, though patients with AIS with higher SHR1 tend to have a higher risk of poor outcome and death and unlikely to develop ENI, these did not reach the statistical significance. In contrast, SHR2 was independently associated with poor functional outcome (per 0.1-point increases: odds ratios (OR) = 1.383 95% CI [1.147–1.668]). Further adjusted for body mass index (BMI), triglyceride-glucose index (TyG), and diabetes slightly strengthen the association between SHR (both 1 and 2) and adverse outcomes. In subgroup analysis, elevated SHR1 is associated with poor functional outcomes (per 0.1-point increases: OR = 1.246 95% CI [1.041–1.492]) in non-diabetic individuals and the association between SHR2 and the poor outcomes was attenuated in non-cardioembolic AIS.ConclusionSHR is expected to replace random or fasting glucose concentration as a novel generation of prognostic indicator and a potential therapeutic target.

The association of admission random blood glucose concentration and body-mass index with mortality in COVID-19 patients.

This study aimed to investigate the association between hyperglycemia and body mass index (BMI), along with other associated comorbidities in hospitalized COVID-19 patients among the Indonesian population. This was a retrospective study conducted at Hasan Sadikin Hospital, Bandung between March 1, 2020, and August 30, 2020. Data were analyzed using the chi-square test for categorical data and unpaired t-test and Mann-Whitney alternative test for numerical data using SPSS version 24.0 (IBM SPSS Statistics for Windows, Version 24.0. IBM, Armonk, NY, USA) and GraphPad Prism version 7.0 for Windows. A total of 142 hospitalized COVID-19 patients were documented between March and August 2020 at the Hasan Sadikin Hospital. Among the 142 patients, 116 (81.7%) survived, while 26 (18.3%) died. Sex, age, BMI, number of comorbidities, heart rate, respiratory rate, peripheral oxygen saturation, platelet count, random blood glucose (RBG), and length of stay (LOS) were significantly associated with mortality. Multivariate analyses demonstrated that admission RBG levels > 140 mg/dl were independently associated with an increased risk of mortality in COVID-19 patients (OR 4.3, 95% CI 1.1-17.5, p = 0.043), while BMI > 25 kg/m2 was significantly associated with reduced mortality (OR, 0.22; 95% CI 0.05-0.88, p = 0.033). Admission hyperglycemia, indicated by an increase in RBG levels >140 mg/dL, is independently associated with an increased risk of mortality in hospitalized COVID-19 patients, while obesity (BMI >25 kg/m2) might have protective properties against the risk of death.

An investigation of the relationship of the admission hyperglycemia to severity and 30-day outcome in acute ishemic and intracerebral hemorraghic stroke: A comparative cross sectional study

Background: Hyperglycemia is implicated as deleterious in acute stroke, although the impact may vary by stroke subtype. We sought to determine the frequency of admission hyperglycemia (subcategorized as diabetes related or reactive) and explore the relationship to stroke severity and functional motor outcome in acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) stroke subtypes. Methods: This cross-sectional study recruited 170 stroke patients (85 AIS, 85 ICH) presenting within 72 h of onset. Baseline characteristics including stroke severity (National Institutes of Health Stroke Scale score), random blood glucose (RBG), and glycated hemoglobin (HBA1C) were documented. The outcomes were 30-day case fatality rate (CFR) and functional motor outcome. Results: The frequency of admission hyperglycemia was 24.7% in AIS and 22.4% ICH, with 18.8%/5.9% of AIS and 9.4%/12.9% of ICH presumed diabetes related and reactive, respectively. Stroke severity and infarct size were positively correlated with admission RBG and HBA1C (P = 0.000) in AIS but not ICH. Presumed mechanism of hyperglycemia did not relate significantly with either infarct size or hematoma volume (P > 0.05). Thirty days CFR was higher in AIS with hyperglycemia (42.9%) compared to normoglycemia (12.5%) (P = 0.003), but did not vary significantly in ICH (42.1% with and 36.4% without hyperglycemia; P = 0.65). There was no significant relationship of hyperglycemia to functional outcome in either stroke subtype. Conclusions: The association of admission hyperglycemia to stroke severity and short-term case fatality is evident in AIS. In ICH, hyperglycemia was not associated with significantly greater stroke severity and death at 30 days, even though case fatality was higher in those with hyperglycemia.

High admission blood glucose independently predicts poor prognosis in COVID-19 patients: A systematic review and dose-response meta-analysis

AimsTo investigate the prognostic value of admission blood glucose (BG) in predicting COVID-19 outcomes, including poor composite outcomes (mortality/severity), mortality, and severity. MethodsEligible studies evaluating the association between admission fasting BG (FBG) and random BG (RBG) levels with COVID-19 outcomes were included and assessed for risk of bias with the Quality in Prognosis Studies tool. Random-effects dose-response meta-analysis was conducted to investigate potential linear or non-linear exposure-response gradient. ResultsThe search yielded 35 studies involving a total of 14,502 patients. We discovered independent association between admission FBG and poor COVID-19 prognosis. Furthermore, we demonstrated non-linear relationship between admission FBG and severity (Pnon-linearity < 0.001), where each 1 mmol/L increase augmented the risk of severity by 33% (risk ratio 1.33 [95% CI: 1.26–1.40]). Albeit exhibiting similar trends, study scarcity limited the evidence strength on the independent prognostic value of admission RBG. GRADE assessment yielded high-quality evidence for the association between admission FBG and COVID-19 severity, and moderate-quality evidence for its association with mortality and poor outcomes. ConclusionHigh admission FBG level independently predicted poor COVID-19 prognosis. Further research to confirm the prognostic value of admission RBG and to ascertain the estimated dose-response risk between admission FBG and COVID-19 severity are required.

Association of pre- and post-stroke glycemic status with clinical outcome in spontaneous intracerebral hemorrhage

In this study, we aimed to disclose the association of pre- and post-stroke glycemic status with clinical outcome in patients with spontaneous intracerebral hemorrhage (sICH). It was a multicenter, prospective, observational cohort study, conducted in 13 hospitals in Beijing from January 2014 to September 2016. The association of admission random blood glucose (RBG), fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) with clinical outcome at 90 days after sICH onset were analyzed comprehensively. Poor outcome was defined as death or modified Rankin Scale (mRS) score >2. The results showed that elevated RBG and FBG were associated with larger hematoma volume, lower GCS, higher NIHSS (P < 0.001), and poor outcome, but HbA1c was not (P > 0.05). In stratified analysis, the association of poor outcome with elevated FBG or RBG retained statistical significance just in patients without diabetes. Kaplan-Meier curve and Cox regression showed that patients with elevated FBG or RBG had significantly higher risk of death within 90 days (P < 0.05). So we conclude that poststroke hyperglycemia was associated with larger hematoma volume, severe neurological damage and poor clinical outcome, but HbA1c was not relevant to hematoma volume or clinical outcome in patients with sICH.

Relationship between Random Blood Glucose, Fasting Blood Glucose, and Gensini Score in Patients with Acute Myocardial Infarction.

Objective To examine the relationship between admission random blood glucose (RBG), fasting blood glucose (FBG), and Gensini score in patients with acute myocardial infarction (AMI) to clarify the effects of RBG and FBG on the severity of coronary artery disease. Method A total of 958 consecutive AMI patients who underwent emergency coronary angiography at the Cardiology Department of Zhongda Hospital (affiliated with Southeast University) were enrolled in this study from January 1, 2016, to December 31, 2018. The Gensini score of each patient was calculated according to the results of coronary angiography. The RBG, FBG, baseline data, hematological indexes, echocardiography parameters, coronary angiography data, and the use of intra-aortic balloon pump (IABP) were recorded. Patients with an RBG level >11.1 mmol/L were classified into the stress hyperglycemia group, and those with an FBG level >7.0 mmol/L were classified into the elevated FBG group. The Gensini scores in the stress hyperglycemia and elevated FBG groups were compared to those in the control group, and correlations between the RBG and FBG levels and the Gensini scores of AMI patients were evaluated. Independent risk factors for the Gensini score were analyzed by multiple linear and multiple logistic regression analyses. Results The Gensini scores of the stress hyperglycemia group and the elevated FBG group were higher than those of the control group. RBG and FBG were positively correlated with the Gensini score, and there were significant differences between RBG and FBG in different Gensini score groups. After adjusting for confounding factors, multiple linear regression analysis showed that sex, diabetes, estimated glomerular filtration rate (eGFR), and FBG were independent risk factors for the Gensini score. Multiple logistic regression analysis showed that age and FBG were independent risk factors in group 2 compared to group 1, eGFR and FBG were independent risk factors in group 3, and eGFR and FBG were independent risk factors in group 4. Diabetes and RBG were not independent risk factors for the Gensini score. Conclusion The Gensini scores of patients in the stress hyperglycemia group and the elevated FBG group were significantly higher than those in the control group. RBG and FBG were positively correlated with the Gensini score in AMI patients, and FBG was an independent risk factor for the Gensini score in AMI patients.

Effects of Hyperglycemia on the In-hospital and Long-term Prognosis of Patients with Acute ST-segment Elevation Myocardial Infarction

Objective: A large amount of acute ST-segment elevation myocardial infarction (STEMI) patients have stress hyperglycemia on admission, which is associated with poor in-hospital and long-term prognosis. This research aimed to find the effects of hyperglycemia on in-hospital mortality, adverse cardiovascular events and long-term prognosis in patients with STEMI.Method: We conducted a prospective cohort study on 456 STEMI patients from January 2015 to December 2016 in Zhongda hospital affiliated to Southeast University. We recorded the baseline data, then used propensity matching (a ratio of 1:2) to balance the confounding variables and rule out the bias, according to the definition of stress hyperglycemia, admission random blood glucose >11.1 mmol/L, we divided patients into two groups: hyperglycemia group (71 cases) and non-hyperglycemia group (142 cases). We recorded and compared the baseline data, past history, auxiliary examination index, medication usage, coronary angiography data, and inhospital outcome between two groups. One-year follow-up main adverse cardiovascular and cerebrovascular events (MACCE) were recorded by telephone and clinic, we use X2 test to research the relationship between hyperglycemia and in-hospital outcome, we use ROC curve to assess the predictive value of hyperglycemia for in-hospital death both in diabetic and non-diabetic patients. Kaplan-Meier curve and Cox regression are used to evaluate the predictive value of stress hyperglycemia for the long-term prognosis.Result: Stress hyperglycemia occurred in 86 patients (18.9%), of whom 65 had diabetes history. There were 10 patients (14.1%) died in hospital in hyperglycemia group, 6 for malignant arrhythmia, 3 for cardiogenic shock and 1 for cardiac rupture. In the non-hyperglycemia group, the in-hospital mortality is 3.5% (P=0.028). The incidence of malignant arrhythmia and cardiogenic shock were higher in hyperglycemia group than control group (P=0.023, P=0.030). The ROC curve of admission random blood glucose predicting in-hospital deaths for non-diabetic patients and diabetic patients showed the area under curve and 95% CI were 0.627, 0.438 ~ 0.837; 0.786, 0.586 ~ 0.913 respectively. The incidence of one-year follow-up MACCE was about 41.7% in hyperglycemia group, and the incidence in the control group was 27.8% (P=0.018). Gender, age, diabetes, hypertension, previous myocardial infarction, hyperglycemia, left ventricular ejection fraction were included in Cox regression model of one-year followup MACCE in STEMI patients. Stress hyperglycemia was an independent risk factor for one-year follow-up MACCE in STEMI patients (OR=4.398, 95% CI=2.869 ~ 7.483, P<0.001).Conclusion: Hyperglycemia is a predictive factor for in-hospital death in STEMI patients, and it has good predictive value for the long-term prognosis.

37 The Importance of Glycemic Control in Affecting Outcomes of Hospitalized Hypertensive Patients

Introduction: Hypertension and diabetes are two of the leading risk factors for atherosclerosis and its complications, especially heart. There is substantial overlap between diabetes and hypertension in etiology and disease mechanisms. Obesity, inflammation, oxidative stress, and insulin resistance are thought to be the common pathways. The presence of both hypertension and diabetes mellitus confers a higher risk of cardiovascular–renal disease than the presence of either condition alone. In addition, the presence of both hypertension and diabetes mellitus makes the management of both diseases difficult and complicated. Objective: To assess the extent of diabetic involvement towards adverse events and LOS of hypertensive hospitalized patients. Method: This cross-sectional study analyzes hypertensive samples which were hospitalized at National Cardiovascular Center Harapan Kita Indonesia from 2015 until mid-2016. Samples were taken consecutively among non-new ACS patients according to inclusive and exclusive criteria. Bivariate and multivariate analysis were done using SPSS-20 program. Results: Among 263 hypertensive samples hospitalized, the occurrence of worsening renal failure (WRF), length of stay (LOS) > 5 days, and in-hospital death were 23.2%, 62.5%, and 3.3% respectively. After adjustment with other independent variables, only diabetic status was significant in producing longer LOS (OR 2.21; p .028) and occurrence of WRF (OR 2.9; p .004). Systolic BP > 140 mmHg also had a role in worsens the renal (OR 4.13; p < .001). Likewise, admission random blood glucose level > 200 mg/dl became the only significant predictor towards in-hospital death (OR 2.4; p .017). Surprisingly, senility, anemia, LVEF and baseline s-Cr were not one of them. Conclusion: In hypertensive hospitalized patients, we should pay more attentions to diabetic status and blood glucose level, not only to prevent WRF and in-hospital death, but also to shorten LOS.

PP.28.02] FACTORS INFLUENCING THE OUTCOMES OF HYPERTENSIVE HOSPITALIZED PATIENTS

Objective: To assess the extent of diabetic involvement towards adverse events and LOS of hypertensive hospitalized patients. Design and method: This is a cross-sectional study of hypertensive samples which were hospitalized at National Cardiovascular Center Harapan Kita Indonesia from 2015 until mid-2016. Samples were taken consecutively among non-new ACS patients according to inclusive and exclusive criteria. Bivariate and multivariate analysis were done using SPSS-20 program. Results: Among 263 hypertensive samples hospitalized, the occurrence of worsening renal failure (WRF), length of stay (LOS) > 5 days, and in-hospital death were 23.2%, 62.5%, and 3.3% respectively. After adjusted with other independent variables, only diabetic status was significant in producing longer LOS (OR 2.21; p .028) and occurrence of WRF (OR 2.9; p .004). Systolic BP > 140 mmHg also had a role in worsens the renal (OR 4.13; p < .001). Likewise, admission random blood glucose level > 200 mg/dl became the only significant predictor towards in-hospital death (OR 2.4; p .017). Surprisingly, senility, anemia, LVEF and baseline s-Cr were not one of them. Conclusions: In hypertensive hospitalized patients, we should pay more attentions to diabetic status and blood glucose level not only to prevent WRF and in-hospital death, but also to shorten LOS.

ELEVATED AT ADMISSION SERUM NEURON SPECIFIC ENOLASE AND HYPERGLYCEMIA ARE PREDICTORS OF POOR OUTCOME OF POST-RESUSCITATION PATIENTS

Background: Optimal survival following sudden cardiac arrest requires heart and brain resuscitation. In patients who achieve cardiac resuscitation, brain recovery from anoxic injury is variable. Neurological sequelae range from complete recovery to coma with brain death. Thus, ideally outcome assessment would incorporate functional and neurologic status. Objective: Evaluation of the prognostic yield of estimation of at admission random blood glucose (RBG) and serum neuron specific enolase (NSE) levels, and determination of the value of NSE serum level re-estimation 48 hours after admission in resuscitated post-cardiac arrest patients. Patients and Methods: The study included 90 cardiac arrest patients; 75 were out-of-hospital and 15 were in-hospital cardiac arrest. All patients received mild therapeutic hypothermia irrespective of the initial rhythm admission. Blood samples were obtained for estimation of RBG and serum SNE. At 48-hours after admission, serum NSE was re-estimated, and the percentage of change in relation to at-admission level was calculated. Clinical evaluation was conducted using the Acute Physiology and Chronic Health Evaluation (APACHE II). Mortality rate throughout duration of ICU stay was determined. Neurologic outcomes were evaluated using the Cerebral Performance Category (CPC) score collectively as favorable neurological outcome (CPC score of 1-2) or unfavorable outcome (CPC score of 3-5). Results: Mean time elapsed till return of spontaneous circulation (ROSC) since arrival to emergency department was 14.3±3.6; range: 8-19 minutes. Mean ICU stay was 16.3±7.4; range: 3-30 days. Thirty-one patients died (34.4%), 18 patients (20%) had unfavorable neurological outcome (CPC-3), and 41 patients (45.6%) had favorable outcome. Mean at admission RBG levels were significantly higher in non-survivors compared to survivors, with significantly higher levels in survivors had unfavorable outcome compared to those had favorable outcome. Mean levels of serum NSE estimated at admission and 48-hours, and percentage of change were significantly higher in non-survivors compared to survivors, with significantly higher levels in survivors had unfavorable outcome compared to those had favorable outcome. There was a negative significant correlation between survival rate and favorable neurologic outcome and levels of RBG and NSE, patient's age, time till ROSC and APACHE II score. ROSC curve and regression analyses were defined at admission hyperglycemia as the highly significant specific predictor for mortality and high serum NSE kinetics for prediction of unfavorable neurologic outcome. Conclusion: Hyperglycemia could specifically predict mortality and high serum NSE levels estimated at admission and 48-hours later, with elevated percentage of increase which could specifically predict poor neurologic outcome of resuscitated post-arrest patients.

The prevalence of hyperglycaemia and its relationship with mortality, readmissions and length of stay in an older acute surgical population: a multicentre study

BackgroundThe purpose of the study is to examine the prevalence of hyperglycaemia in an older acute surgical population and its effect on clinically relevant outcomes in this setting.MethodsUsing Older Persons...

Comatose and noncomatose adult diabetic ketoacidosis patients at the University Teaching Hospital, Zambia: Clinical profiles, risk factors, and mortality outcomes.

Background:Diabetic ketoacidosis (DKA) is one of the commonly encountered diabetes mellitus emergencies.Aim:This study aimed at describing the clinical profiles and hospitalization outcomes of DKA patients at the University Teaching Hospital (UTH) in Lusaka, Zambia and to investigate the role of coma on mortality outcome.Materials and Methods:This was a cross-sectional analytical study of hospitalized DKA patients at UTH. The data collected included clinical presentation, precipitating factors, laboratory profiles, complications, and hospitalization outcomes. Primary outcome measured was all-cause in-hospital mortality.Results:The median age was 40 years. Treatment noncompliance was the single highest identified risk factor for development of DKA, followed by new detection of diabetes, then infections. Comatose patients were significantly younger, had lower baseline blood pressure readings, and higher baseline respiratory rates compared to noncomatose patients. In addition, comatose patients had higher baseline admission random blood glucose readings. Their baseline sodium and chloride levels were also higher. The prevalences of hypokalemia, hypernatremia, and hyperchloremia were also higher among comatose patients compared to noncomatose patients. Development of aspiration during admission with DKA, pneumonia at baseline, development of renal failure, and altered mental status were associated with an increased risk of mortality. Development of renal failure was independently predictive of mortality.Conclusion:The mortality rate from DKA hospitalizations is high at UTH. Treatment noncompliance is the single highest identifiable precipitant of DKA. Aspiration, development of renal failure, altered sensorium, and pneumonia at baseline are associated with an increased risk of mortality. Development of renal failure during admission is predictive of mortality.

Relationship between injury severity, random blood glucose and management outcome in a cohort of Nigerian patients with head injury.

Objective:This study was designed to evaluate the relationship between injury severity, admission Random Blood Glucose [RBG] and management outcome in a cohort of Nigerian patients with Head Injury [HI].Materials and Methods:RBG was determined at admission, twenty four hours as well as seventy two hours after admission in patients with head injury. Severity of injury was graded using Glasgow Coma Scale (GCS). Outcome of management was determined by Glasgow Outcome Score at discharge. Serum glucose level of ≥ 11.1 mmol/l was taken as hyperglycaemia. Analyses of variance [ANOVA] was used to determine level of significance and a P value of < 0.05 was considered significant.Results:There were 146 male and 30 female patients (range: 2 years to 78 years; mean; 34.4 years, SD: 16.4 years). Most (36.4%) of the patients had severe HI. Only 2.5% of the patients had hyperglycaemia at admission. Death occurred in 25% of the patients, moderate disability occurred in 30.1% and good outcome occurred in 35.8%. Hyperglycaemia occurred in one patient each in mild and severe head injuries and in two patients with moderate head injury. All the patients with hyperglycaemia had favourable outcome.Conclusion:Random blood glucose of ≥ 11.1 mmol/l was not common at admission in head injured patients in this cohort of patients and the value was not associated with severe injury or poor outcome.

Effect of Admission Hyperglycaemia on Infarct Size and Clinical Outcome in Black Patients with Acute ISCHAEMIC Stroke, Northeast Nigeria

Aims: To determine the relationship between admission blood glucose level, infarct size and stroke outcome in black African patients with acute ischaemic stroke. Study Design: The study was cross-sectional. Place and Duration of Study: University of Maiduguri Teaching Hospital, Northeast Nigeria, from January 2006 to January 2009. Methodology: Sixty-two patients were recruited and clinical characteristics recorded. Stroke severity was assessed using the National Institutes of Health Stroke Score Original Research Article British Journal of Medicine & Medical Research, 4(34): 5324-5334, 2014 5325 (NIHSS); disability assessed using Modified Rankin score (mRS) and Barthel Activity of Daily Living (ADL) index (BI). Infarct volume was calculated from CT scan using the ‘method of measurements of the largest diameters’. Random blood glucose (RBG) was measured on admission, and dichotomised into those with hyperglycaemia > 7mmol/L those without < 7 mmol/L. Bivariate statistics were used to compare characteristics and outcome. Kaplan-Meier Statistic was used to compare mortality rates. The influence of hyperglycaemia on infarct volume and outcome was determined using logistic regression. Results: Fourteen (22.6%) patients had hyperglycaemia on admission. Those with hyperglycaemia had a larger infarct volume (P < .0001) and higher NIHSS (P = .003) on presentation. They had worse stroke outcome (Discharge BI: P = .001; NIHSS: P < 0.0001; mRS: P = .001) and higher 30-day mortality (P = .005). Admission RBG positively correlated with infarct size (P < .001), NIHSS (P = .01), mRS (P = .02) and negatively with BI (P = .02). Survival time is significant with Log Rank (P = .009) and Wilcoxon test statistics (P = .006). Hyperglycaemia predicted a larger infarct (OR = 4.46, P = < .0001), poorer NIHSS on discharge (OR = 3.44, P = .001), poorer mRS (OR = 2.53, P = .02) and 30 – day mortality (OR = 2.04, P = .046). Conclusion: Hyperglycaemia is associated with a larger infarct size, severe stroke at presentation and a worse stroke outcome.

Impact of Blood Glucose Levels on Contrast Induced Nephropathy after Percutaneous Coronary Intervention in Patients not known to be Diabetic with Acute Coronary Syndrome.

Background: Contrast-Induced Nephropathy (CIN) is an iatrogenic disorder, resulting from exposure to contrast media. The association between pre-procedural blood glucose levels and CI-AKI risk (regardless of pre-existing diabetes) is unknown. The present study was conducted to evaluate the incidence of CI-AKI in patients with admission hyperglycemia in non-diabetic ACS patients. Methods: This is Prospective, observational study done in the department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka. Considering inclusion and exclusion criteria, 50 patients were non diabetic with ACS with normal blood glucose (d”7.8 mmol/l or d”140 mg/dl) in (Group I) and 50 patients were non diabetic with ACS with high blood glucose (&gt;7.8 mmol/l or &gt;140 mg/dl) undergoing percutaneous coronary intervention in (Group II). On admission random blood glucose was measured. Non- ionic low osmolar contrast agents (lopamidol) was used in all patients. Serum creatinine, serum electrolytes was measured and creatinine clearance rate was determined within 24 hours before PCI and day 1 and 2 after PCI. Results: The incidence of CIN was 24% in high blood glucose group and 4% in normal blood glucose group (p=0.004). It was also observed that gradual incremental increase in risk of CIN associated with higher admission blood glucose level. There was positive correlation between s. creatinine and admission blood glucose but it showed negative correlation between CCr and admission blood glucose after PCI in ACS patients not known to be diabetic. Conclusion: The present study reveals that index admission high blood glucose in acute coronary syndrome patients not known to be diabetic is associated with increased incidence of contrast induced nephropathy after percutaneous coronary intervention. Cardiovascular Journal Volume 6, No. 1, 2013, Page 23-30 DOI: http://dx.doi.org/10.3329/cardio.v6i1.16111

Predictors of short-term intra-hospital case fatality following first-ever acute ischaemic stroke in Nigerians.

To determine the predictors of 30-day intra-hospital case fatality rate in patients with first-ever acute ischaemic stroke, attending a tertiary care hospital in Western Nigeria. A cross-sectional observational study. This study was conducted at the Lagos University Teaching Hospital, Lagos, Nigeria between February 2003 and May 2004 (16 months). One hundred consecutively consenting patients admitted within 72 hours of onset of first-ever acute ischaemic stroke were studied. Uniform information was obtained using a standard format documenting demographic information, stroke-related symptoms and signs, risk factor profile, admission Glasgow Coma Score (GCS), stroke severity, admission Random Blood Glucose (RBG) and presence of complications. All patients were closely followed-up to monitor progress and document any complications. The end point was mortality or survival at 30 days from stroke onset. The 30-day case fatality rate was 28%. In univariate analysis, the factors predicting mortality were admission stroke severity, admission hyperglycaemia, admission level of consciousness, and presence of any complication during the hospitalization period. Of these factors, presence of complications had the strongest correlation with 30-day case fatality (r = 0.52; p = 0.001). Presence of complications was the most important predictor of short-term mortality in Nigerians with firstever acute ischaemic stroke. Prevention, early detection, and aggressive intervention to treat complications may reduce the unacceptably high mortality rate of ischaemic stroke in our environment.