Admission hyperglycemia an independent predictor of outcome in acute ischemic stroke: A longitudinal study from a tertiary care hospital in South India

Abstract

Background: Stroke is one of the important causes of long-term disabilityrelated deaths worldwide. Incidence and prevalence of stroke have been steadily increasing in India. Increasing interest has been focused on the role of admission hyperglycemia in the evolution of acute ischemic stroke. Very few studies were conducted in south India; hence, we intended to do this study.

Methods: A total of 198 patients with acute ischemic stroke were included in a hospital-based longitudinal study to identify the independent factors (demographic, clinical, and biochemical parameters) associated with poor outcome (functional impairment— mRS ≥ 3 and mortality at 90 days of follow-up.

Results: Nearly, 75% of the patients presented with moderate-to-severe stroke. Out of the 198 patients, 117 (59%) had severe disability at admission. At 90 days of follow-up, it was observed that only 10 (5.5%) had severe disability. Patients with hyperglycemia exhibited greater functional impairment, that is, 96 out of 111 study subjects had modified Rankin score (mRS) ≥3, than those with normoglycemia (P < 0.0001). Mortality was high in hyperglycemics when compared with normoglycemics, that is, out of the 20 deaths, 13 patients had hyperglycemia and seven had normoglycemia at presentation (P < 0.015). Logistic regression analysis predicted that higher capillary blood glucose at first presentation, moderate-to-severe stroke, poor drug compliance, stress hyperglycemia, and newly detected diabetes mellitus were associated with poor functional outcome at 90 days of follow-up.

Conclusion: Stress hyperglycemia in stroke was associated with higher risk of poor functional outcome in acute ischemic stroke. Hyperglycemia at stroke onset without prior history of diabetes mellitus have particularly poor prognosis, than those with hyperglycemia in known diabetes.

Keywords: Acute ischemic stroke, diabetes mellitus, stress hyperglycemia