Impact of hyperglycemia on ischemic stroke mortality in diabetic and non-diabetic patients

Vanja Basic Kes, Vesna Vargek Solter, Visnja Supanc, Vida Demarin, Vanja Basic Kes, Vesna Vargek Solter, Visnja Supanc, Vida Demarin

Abstract

Background: Previous studies suggest that infarct expansion may be responsible for increased mortality after stroke onset in patients with prolonged stress hyperglycemia. Therefore, we evaluated the influence of prolonged stress hyperglycemia on stroke mortality in patients with and without diabetes.

Patients and methods: For 630 stroke patients admitted to the neurological intensive care department within 24 hours of stroke onset, we correlated mean blood glucose levels (MBGL) at admission and 72 hours after admission in diabetic and non-diabetic patients with final outcome. Blood glucose levels higher then 6.1 mmol/L (121 mg/dL) were treated as hyperglycemia.

Results: Of 630 patients (mean age 71 A+/- 6), 410 were non-diabetic (mortality, 25%) and 220 patients were diabetic (mortality, 20%). All patients who died within 28 days of hospitalization had prolonged hyperglycemia (at admission and after 72 hours, despite insulin therapy). The unadjusted relative risk of in-hospital mortality within 28 days for all stroke patients was 0.68 (95% CI, 0.14-1.9) for non-diabetic patients and 0.39 (95% CI, 0.27- 1.56) for diabetic patients. The unadjusted relative risk of in-hospital mortality within 28 days in ischemic stroke in patients with MBGL > 6.1-8.0 mmol/L (121-144 mg/dL) at admission and after 72 hours was 1.83 (95% CI, 0.41-5.5) for non-diabetic patients and 1.13 (95% CI, 0.78-4.5) for diabetic patients. Non-diabetic patients with hyperglycemia had a 1.7 times higher relative risk of in-hospital 28-day mortality than patients with diabetes.

Conclusion: Prolonged stress hyperglycemia in ischemic stroke patients increases the risk of in-hospital 28- day mortality, especially in non-diabetic patients.

Figures

Figure 1
Figure 1
Unadjusted relative risk of in-hospital mortality within 30 days.

References

    1. Demarin V. Stroke-present state and perspective. Period bio. 1995;l 97:95–97.
    1. Lovrenčić Huzjan A, Bosnar M, Huzjan R, Demarin V. Frequency of different risk factors for ischemic stroke. Acta clin Croat. 1999;38:159–163.
    1. Demarin V, Lovrenčić-Huzjan A, Šerić V, Vargek-Solter V, Trkanjec Z, Vuković V, Lupret V, Kalousek M, De Syo D, Kadojić D, Lušić I, Dikanovic M, Vitas M. Recommendations for stroke management. Acta clin Croat. 2001;40:127–154.
    1. Klijn CMJ, Hankey GJ. Management of acute ischemic stroke: new guidelines from American Stroke Association and European Stroke Initiative. Lancet. 2003;2:698–701.
    1. Baird TA, Parsons MW, Phanh T, Butcher KS, Desmond PM, Tress BM, Colman PG, Chambers BR, Davis SM. Persistent poststroke hyperglycemia is independently associated with infarct volume expansion and worse clinical outcome. Stroke. 2003;34:2208–2214.
    1. Parsons MW, Barber PA, Desmond PM, Baird TA, Darby DG, Byrnes G, Tress BM, Davis SM. Acute hyperglycemia adversely affects stroke outcome: a magnetic resonance imaging and spectroscopy study. Ann Neurol. 2002;52:20–28.
    1. Kernan WN, Inzucchi SE, Viscoli CM, Brass LM, Bravata DM, Horwitz RL. Insulin resistance and the risk for stroke. Neurology. 2002;59:809–815.
    1. Anderson RE, Tan WK, Martin HS, Meyer FB. Effects of glucose and PaO2 modulation on cortical intracellular acidosis. NADH redox state and the infarction in ischemic penumbra. Stroke. 1999;30:160–170.
    1. Guyot LL, et al. The effect of streptozotocin-induced diabetes on the release of exocitotoxic and other amino acids from the ischemic rat cerebral cortex. Neurosurgery. 2001;48:385–390.
    1. Zhang RL, Lu CZ, Ren HM, Xiao BG. Metabolic changes of arachidonic acid after cerebral ischenia-reperfusion in diabetic rats. Experimental Neurology. 2003;184:746–752.
    1. Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein Hc. Stress hyperglycemia and prognosis of stroke in diabetic and nondiabetic patients-a systematic rewiev. Stroke. 2001;32:2426–2432.
    1. Scott JF, Robinson GM, French JM, O’Connell JE, Alberti KG, Gray CS. Glucose potassium insulin infusions in the treatement of acute stroke patients with mild or moderate hyperglycemia: the Glucose Insulin in Stroke Trial (GIST) Stroke. 1999;30:793–799.
    1. Jorgensen H, Nakayama H, Raaschou HO, Olsen TS. Stroke in patients with diabetes in Copenhagen Stroke Study. Stroke. 1994;25:1977–1984.
    1. Bruno A, Biller J, Adams HP, Clark WR, Woolson RF, Wiliams LS, Hansen MD. Acute blood glucose level and outcome from ischemic stroke: Trial of ORG 10172 in Acute Stroke Treatement (TOAST) Investigators. Neurology. 1999;52:280–284.
    1. Bruno A, Levine SR, Frankel MR, Brott TG, Kwiatkowski TG, Fineberg SE the NINDS rt-PA Stroke Study Group. Adission glucose level and clinical outcomes in the NINDS rt-PA Stroke Trial. Neurology. 2002;59:669–674.
    1. Alvarez-Sabin J, Molina CA, Montaner J, Arenillas JF, Huertas R, Ribo M, Codina A, Quintana M. Effects of admission hyperglycemia on stroke outcome in reperfused tissue plasminogen activator-treated patients. Stroke. 2003;34:1235–1241.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться