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

Abstract

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.

Prognostic Signification of Admission Hyperglycemia among Acute Stroke Patients in Intensive Care Units in Kinshasa, the Democratic Republic of the Congo

“…In this regard, Masrur et al [1] found that blood glucose > 140 mg/dL (adjusted OR 1.68; 95%CI 1.57 -1.80) in patients with acute stroke was independently associated with in-hospital mortality. Similarly Marulaiah et al [2] reported a significantly (p < 0.0001) higher mortality rates in hyperglycemic than normoglycemic stroke patients.…”

“…Even though most studies have shown that hyperglycemia at admission confers a worse prognosis following acute stroke, it is still unclear whether it only reflects stroke severity or it is directly associated with outcomes [2] [32]. Although some studies have suggested acute hyperglycemia as a marker of stroke severity, the majority of basic science research support the theory that hyperglycemia at admission leads to worsened outcomes through its direct toxic effects on the brain tissue (in particular to the vulnerable ischemic penumbra) possibly because of the accumulation of lactic acid secondary to anaerobic metabolism, enhanced excitatory neurotransmitter (glutamate, aspartate) release, and increased cerebral edema [2] [33]. Hyperglycemia has been also reported to promote oxidative stress, inflammation and neuronal apoptosis, alter cerebral microcirculation with subsequent blood-brain barrier disruption [33] [34] [35].…”

“…Among potential predictors, admission hyperglycemia has been reported to be a substantial contributor [1]. Indeed, increased admission blood glucose levels in acute stroke have been reported to be associated with longer in-hospital stay, increased costs and mortality [1] [2]. Hyperglycemia is found in more than half of patients with stroke with most of them not having a known history of diabetes mellitus [1] [2].…”

“…Indeed, increased admission blood glucose levels in acute stroke have been reported to be associated with longer in-hospital stay, increased costs and mortality [1] [2]. Hyperglycemia is found in more than half of patients with stroke with most of them not having a known history of diabetes mellitus [1] [2]. In some patients, hyperglycemia is considered a reflection of preexisting but unrecognized diabetes mellitus; however, more often, it is the result of an acute stress response, typically termed stress hyperglycemia [1] [2].…”

“…The toxic effects of hyperglycemia to the brain tissue are thought to rely upon several biochemical and hemodynamic mechanisms including the accumulation of lactic acid due to anaerobic metabolism, enhanced glutamate release, and increased cerebral edema [1] [2] [3]. Therefore, the evaluation of the relative contribution of admission hyperglycemia to the risk of death in the acute phase of stroke could help improve the outcome of patients with acute stroke [1] [2] [3].…”