Blood glucose level on admission as potential indicator of in-hospital mortality in non-diabetic patients presenting with acute stroke

Authors

  • Avtar Singh Dhanju Department of Medicine, Government Medical College, Amritsar, Punjab, India
  • Inderjit Singh Department of Medicine, Government Medical College, Amritsar, Punjab, India
  • Namit Gupta Department of Medicine, Government Medical College, Amritsar, Punjab, India http://orcid.org/0000-0002-7096-2673
  • Pashaura Singh Sandhu Department of Medicine, Government Medical College, Amritsar, Punjab, India
  • Hargun Singh Sidhu Government Medical College, Amritsar, Punjab, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20220787

Keywords:

Diabetes mellitus, Mortality, Stress hyperglycemia, Stroke

Abstract

Background: A stroke or cerebrovascular accident is defined as an abrupt onset of a neurologic deficit that is attributable to a focal vascular cause. Stress hyperglycemia has been defined as hyperglycemia in previously euglycemic patients that corrects once the acute process resolves.

Methods: The present study was conducted in the medicine department, Guru Nanak Dev hospital attached to government medical college, Amritsar from April 2021-December 2021 after taking approval from institutional ethics committee. This was a prospective observational study. A total of 50 non-diabetic patients of acute stroke with age group >18 to <75 of either sex were enrolled in this study. Comparison of mortality was done in hyperglycemic and non hypergylcemic non-diabetic patients on 1st day of admission and up to 10th day during hospital stay.

Results: Mortality percentage on day 1 was higher among those who had high blood glucose levels but there was no significant association between glucose levels and day 1 outcome (survival or death) observed in our study (p=0.078). Mortality percentage on day 10 was higher among those who had high blood glucose levels and there was significant association between glucose levels and day 10 outcome (survival or death) observed in our study (p=0.001). A significant association was observed between glucose levels and overall outcome in our study (p<0.001).

Conclusions: We conclude that even in non-diabetic patients, hyperglycemia on admission is independently associated with a higher risk of in-hospital mortality.

References

Smith WS, Johnston SC, Hemphill JC III. Cerebrovascular Diseases in Harrison’s Principles of Internal Medicine, 20th Edition. 2018;3068.

Mariani E, Polidori MC, Cherubini. Oxidative stress in brain aging, neurodegenerative and vascular diseases: An overview. J Chromat B. 2005;827(1):65-75.

Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M et al. American Heart Association Statistics Committee. Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2016 Update: A Report from the American Heart Association. Circulation. 2016;133(4):e38-60.

Chen R, Ovbiagele B, Feng W. Diabetes and stroke: epidemiology, pathophysiology, pharmaceuticals and outcomes. Am J Med Sci. 2016;351(4):380-6.

Dungan KM, Braithwaite SS, Preiser JC. Stress hyperglycaemia. Lancet. 2009;373(9677):1798-807.

Roberts GW, Quinn SJ, Valentine N, Alhawassi T, O'Dea H, Stranks SN et al. Relative hyperglycemia, a marker of critical illness: introducing the stress hyperglycemia ratio. J Clin Endocrinol Metab. 2015;100(12):4490-7.

Anderson RE, Tan WK, Martin HS, Meyer FB. Effects of glucose and PaO2 modulation on cortical intracellular acidosis, NADH redox state, and infarction in the ischemic penumbra. Stroke. 199930(1):160-70.

Kawai N, Keep RF, Betz AL, Nagao S. Hyperglycemia induces progressive changes in the cerebral microvasculature and blood-brain barrier transport during focal cerebral ischemia. Acta Neurochir Suppl. 1998;71:219-21.

Manickam S, Franklin J, Petchiappan V, Menon S. A study of serum albumin levels in acute ischemic stroke and its association with clinical outcome. Int J Contemporary Med Res. 2019;6(3):C17-20.

Abbasi V, Fattahzadeh-Ardalani G, Safarnejad P, Aslanian R. Albumin impact on clinical practice and complications of ischemic stroke in patients with stroke. Int J Basic Clin Pharmacol. 2016;5(5):2114-7.

Boehme AK, Esenwa C, Elkind MS. Stroke Risk Factors, Genetics, and Prevention. Circ Res. 2017;120(3):472-95.

Deresse B, Shaweno D. Epidemiology and in-hospital outcome of stroke in South Ethiopia. J Neurol Sci. 2015;355(1-2):138-42.

Tirschwell DL, Ton TG, Ly KA, Van Ngo Q, Vo TT, Pham CH et al. A prospective cohort study of stroke characteristics, care, and mortality in a hospital stroke registry in Vietnam. BMC Neurol. 2012;12:150.

Marulaiah SK, Reddy MP, Basavegowda M, Ramaswamy P, Adarsh LS. Admission hyperglycemia an independent predictor of outcome in acute ischemic stroke: a longitudinal study from a tertiary care hospital in South India. Niger J Clin Pract. 2017;20(5):573-80.

Snarska KK, Bachórzewska-Gajewska H, Kapica-Topczewska K, Drozdowski W, Chorąży M, Kułakowska A et al. Hyperglycemia and diabetes have different impacts on outcome of ischemic and hemorrhagic stroke. Arch Med Sci AMS. 2017;13(1):100.

Nardi K, Milia P, Eusebi P, Paciaroni M, Caso V, Agnelli G. Predictive value of admission blood glucose level on short-term mortality in acute cerebral ischemia. J Diabetes Complic. 2012; 26(2):70-6.

Zhu B, Pan Y, Jing J, Meng X, Zhao X, Liu L et al. Stress Hyperglycemia and Outcome of Non-diabetic Patients After Acute Ischemic Stroke. Front Neurol. 2019;10:1003.

Farrokhnia N, Björk E, Lindbäck J, Terént A. Blood glucose in acute stroke, different therapeutic targets for diabetic and non‐diabetic patients? Acta neurologica scandinavica. 2005;112(2):81-7.

Tziomalos K, Dimitriou P, Bouziana SD, Spanou M, Kostaki S, Angelopoulou SM et al. Stress hypergylcemia and acute ischemic stroke im-hospital outcome. Metabolism. 2017;67:99-105.

Szczudlik A, Slowik A, Turaj W. Transient hyperglycemia in ischemic stroke patients. J Neurol Sci. 2001;189:105-11.

Freire AX, Bridges L, Umpierrez GE, Kuhl D, Kitabchi AE. Admission hyperglycemia and other risk factors as predictors of hospital mortality in a medical ICU population. Chest. 2005;128(5):3109-16.

Nakayama H, Jørgensen HS, Raaschou HO, Olsen TS. The influence of age on stroke outcome. Copenhagen Stroke Study Stroke. 1994;25(4):808-13.

Gustavo S, Cote R, Phillips S, Gubitz G, Bayer N, Minuk J et al. Stroke Outcome in Those Over 80 A Multicenter Cohort Study Across Canada. Stroke. 2008;39(8):2310-17.

Downloads

Published

2022-03-24

Issue

Section

Original Research Articles