Range of glucose as a glycemic variability and 3–month outcome in diabetic patients with acute ischemic stroke

Abstract Background Hyperglycemia is a risk factor for infarct expansion and poor outcome for both diabetic and non-diabetic patients. We aimed to study the prognostic value of stress hyperglycemia on the outcome of acute ischemic stroke patients as regards National Institutes of Health Stroke Scale (NIHSS) as a primary outcome. Results Patients with high random blood sugar (RBS) on admission showed significantly higher values of both median NIHSS score and median duration of hospital stay. There were significant associations between stress hyperglycemia and the risk of 30-day mortality (p < 0.001), the need for mechanical ventilation (p < 0.001) and vasopressors (p < 0.001), and the occurrence of hemorrhagic transformation (p = 0.001). The 24-h RBS levels at a cut off > 145 mg/dl showed a significantly good discrimination power for 30-day mortality (area under the curve = 0.809). Conclusions Stress hyperglycemia had a prognostic value and was associated with less-favorable outcomes of acute stroke patients. Therefore, early glycemic control is recommended for those patients.

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Hyperuricemia and prognosis of acute ischemic stroke in diabetic patients

Neurological Research ◽

10.1080/01616412.2018.1553347 ◽

2018 ◽

Vol 41 (3) ◽

pp. 250-256 ◽

Cited By ~ 1

Author(s):

Ping Wang ◽

Xinyan Li ◽

Chaoming He ◽

Yun Zhai ◽

Hongwei Sun ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Diabetic Patients

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Thrombolysis Outcomes in Patients with Diabetes and Previous Stroke: A Meta-Analysis

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2020.63 ◽

2020 ◽

Vol 47 (4) ◽

pp. 486-493

Author(s):

Azalea T. Pajo ◽

Jose Danilo B. Diestro ◽

Adrian I. Espiritu ◽

Adam A. Dmytriw ◽

Alejandro Enriquez-Marulanda ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Meta Analysis ◽

Functional Independence ◽

Tissue Type ◽

Diabetic Patients ◽

Eligibility Criteria ◽

Symptomatic Intracerebral Hemorrhage ◽

Patients With Diabetes ◽

Newcastle Ottawa Scale

ABSTRACT:Background:Intravenous tissue-type plasminogen activator (IVtPA) is a proven treatment for acute ischemic stroke; however, diabetes mellitus (DM) and previous cerebral infarction (PCI) were considered relative contraindications for thrombolysis within the 3–4.5 h period.Objective:The study aimed to determine the safety and efficacy of IVtPA among diabetic patients with PCI presenting with acute ischemic stroke.Methods:Studies which evaluated the outcome of IVtPA in terms of symptomatic intracerebral hemorrhage (sICH), functional outcome in modified Rankin scale, and death among diabetic patients with PCI presenting with acute ischemic stroke within the 3–4.5 h period were systematically searched until July 2019. Screening and eligibility criteria were applied. Risk of bias was evaluated using the Newcastle–Ottawa Scale. Odds ratios (ORs) with 95% confidence interval (CI) were used to compare measures of treatment effect. Mantel–Haenszel method and random-effects model were also employed.Results:Four registry-based studies with a total of 44,572 patients were included for quantitative synthesis. Giving IVtPA among DM+/PCI+ patients did not result in significantly increased rate of sICH (OR, 1.09; 95% CI, 0.88, 1.36) compared to No DM+/PCI+ patients. However, there was significantly higher mortality (OR, 1.81; 95% CI, 1.60, 2.06) in the DM+/PCI+ group. Conversely, among those who survived, the DM+/PCI+ patients were more functionally independent at 3 months (OR, 0.76; 95% CI, 0.61, 0.94).Conclusion:Limited evidence suggests that thrombolysis in DM+/PCI+ patients does not result in significantly higher incidence of sICH and may improve functional independence. However, the significantly higher mortality in this group warrants an assessment of the individualized risk–benefit ratio in the use of IVtPA.

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Effects of glycemic variability and hyperglycemia in acute ischemic stroke on post-stroke cognitive impairments

Journal of Diabetes and its Complications ◽

10.1016/j.jdiacomp.2018.02.006 ◽

2018 ◽

Vol 32 (7) ◽

pp. 682-687 ◽

Cited By ~ 6

Author(s):

Jae-Sung Lim ◽

Chulho Kim ◽

Mi Sun Oh ◽

Ju-Hun Lee ◽

San Jung ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Cognitive Impairments ◽

Glycemic Variability ◽

Post Stroke

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[P2-265]: GLYCEMIC VARIABILITY IN ACUTE ISCHEMIC STROKE AND COGNITIVE OUTCOME

Alzheimer s & Dementia ◽

10.1016/j.jalz.2017.06.918 ◽

2017 ◽

Vol 13 (7S_Part_14) ◽

pp. P715-P715

Author(s):

Jae-Sung Lim ◽

Chulho Kim ◽

Mi Sun Oh ◽

Sang Won Suh ◽

Byung-Chul Lee ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Glycemic Variability ◽

Cognitive Outcome

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Current data about localization of acute ischemic stroke and prognostic factors in diabetic and non-diabetic patients

Romanian Journal of Medical Practice ◽

10.37897/rjmp.2021.2.19 ◽

2021 ◽

Vol 16 (2) ◽

pp. 215-224

Author(s):

Nicolae Ovidiu POP ◽

◽

Petru Aurel BABEȘ ◽

Larisa Bianca HOLHOȘ ◽

Eugenia GAVRILUȚ ◽

...

Keyword(s):

Diabetes Mellitus ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Cerebral Artery ◽

Current Data ◽

Diabetic Patients ◽

Established Risk Factor ◽

Significant Difference ◽

Elevated Cholesterol ◽

Prospective Longitudinal

Introduction. Ischemic stroke accounts for approximately 85% of all vascular accidents and has a high number of identified risk factors, including transient ischemic attack, smoking, metabolic syndrome, alcohol consumption, elevated cholesterol levels and artery stenosis carotid. Diabetes mellitus (DM) is a well-established risk factor for ischemic stroke. Material and method. This prospective longitudinal observational study highlights the importance of localization of ischemic stroke, including 340 patients with acute ischemic stroke with / without diabetes mellitus. The database was collected in a Microsoft Excel document. The correlation analysis was processed in the MedCalc 14.1 program where correlation tests included in the program were used. Results. The predominant localization of ischemic stroke in diabetic patients was the middle cerebral artery followed by the posterior cerebral artery and the double localization compared to the group witness where the same trend is maintained (p = 0.22). The correlation between the localization of the acute ischemic stroke with the age 64.5 for MCA, 64.6 for PCA, and 73.57 for DL (CI 95%, p= 0.02). The correlation of the NIHSS severity score with the location of ischemic strokes was also obtained: average NIHSS score 18.9 points for MCA, 18.5 for PCA, 24 for DL (CI 95, p < 0.0001). The data obtained from the Kaplan-Meier analysis on the survival rate of the patients (divided by the vascular territory involved), provided an expected result difference (statistically significant, p < 0.0001). Conclusions. There is no statistically significant difference between diabetic vs. non-diabetic patients regarding the localization correlated with DM, the double location being statistically insignificant between the two batches. The double location having a higher frequency in elderly patients.

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Stress hyperglycemia is associated with in-hospital mortality in patients with diabetes and acute ischemic stroke

10.21203/rs.3.rs-54844/v1 ◽

2020 ◽

Author(s):

Donghua Mi ◽

Zixiao Li ◽

Hongqiu Gu ◽

Yin Yang ◽

Chunjuan Wang ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Cardiovascular Risk ◽

Acute Ischemic Stroke ◽

Cardiovascular Risk Factors ◽

Fasting Blood Glucose ◽

Hospital Death ◽

Diabetic Patients ◽

Stress Hyperglycemia ◽

Patients With Diabetes

Abstract Background and Objective: Stress hyperglycemia may occur in diabetic patients with acute severe cerebrovascular disease, but the results regarding its association with stroke outcomes are conflicting.Our study aimed to examine the association between stress-induced hyperglycemia and the occurrence of in-hospital death in patients with diabetes and acute ischemic stroke. Research Design and Methods: All data were from the Chinese Stroke Center Alliance (CSCA) database and were collected between 2016 and 2018 from > 300 centers across China. Patients’ demographics, clinical presentation, and laboratory data were extracted from the database. The primary endpoint was in-hospital death. The ratio of fasting blood glucose (FBG) to HbA1c was calculated, i.e., the stress-induced hyperglycemia ratio (SHR), to determine stress hyperglycemia following acute ischemic stroke. Results A total of 168,381 patients were included. The mean age was 66.2 ± 10.7, and 77,688 (43.0%) patients were female. The patients were divided into two groups: survivors (n = 167,499) and non-survivors (n = 882), as well as into four groups according to their SHR quartiles (n = 42,090 − 42,099/quartile). The frequencies of traditional cardiovascular risk factors increased with the SHR quartiles. There were 109 (0.26%), 142 (0.34%), 196 (0.47%), and 435 (1.03%) patients who died in the Q1, Q2, Q3, and Q4 quartiles, respectively. Compared with Q1 patients, the death risk was higher in Q4 patients (odds ratio (OR) = 4.02) (adjusted OR = 1.89, 95% confidence interval [CI] = 1.14–3.12, P = 0.026 after adjustment for traditional cardiovascular risk factors). Conclusions The SHR may serve as an accessory parameter for the prognosis of patients with diabetes after acute ischemic stroke.Hyperglycemia in stroke patients with diabetes mellitus is associated with a higher risk of in-hospital death.

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