The frequency and impact of admission hyperglycemia on short term outcome of acute stroke patients admitted to Tikur Anbessa Teaching Hospital, Addis Ababa, Ethiopia: a cross-sectional study

Abstract Background: Admission hyperglycemia (HG) has been associated with worse outcomes among acute stroke patients. A better understanding and awareness of the potentially adverse influence of hyperglycemia on the clinical outcome of acute stroke patients would help to provide guidance for acute stroke management and prevention of its adverse outcomes. We aimed to assess the frequency of admission hyperglycemia and its impact on short term (30-days) morbidity and mortality outcomes of stroke in adult Ethiopian patients in an urban setting.Methods: A prospective, cross-sectional study was conducted among acute stroke patients admitted to Tikur Anbessa Specialized Hospital (TASH), within 72 hours of symptom onset, from July to December 2016. Socio-demographic data, neuroimaging findings and capillary blood glucose values were obtained on admission. Hyperglycemia was defined as >140mg/dl. National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to assess the baseline stroke severity and the 30-days post-stroke outcome, respectively.Results: A total of 103 first-ever acute stroke patients were included (mean age = 55.5+15.3 years, 64.1% male and 65% under the age of 65 years) and 51 (49.5%) were hyperglycemic at time of admission. The median admission NIHSS score was worse in the hyperglycemic patients 14 (IQR 10-19) compared to normoglycemic patients 11 (IQR 8-15). Among stroke survivors, patients with hyperglycemia were 3.83 times (95% CI, 1.99-6.19) more likely to be functionally impaired (mRS = 3-5) at 30-days compared to normoglycemic patients (p = 0.041).Older age (≥ 65 years) (p = 0.017) and stroke severity (NIHSS >14) (p = 0.006) at admission were both significantly associated with poor functional recovery at 30-day. Among the patients who died at 30-day, two-third (66.7%) were hyperglycemic but they failed to show any significant association.Conclusions: Hyperglycemia is prevalent among Ethiopian stroke patients at the time of presentation and it is associated with significantly poor functional recovery at 30th-days of follow up. This finding provides a rationale for achieving normal blood glucose in the course of acute stroke management which could have a favorable impact on the neurological outcome and quality of life for patients.

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The frequency and impact of admission hyperglycemia on short term outcome of acute stroke patients admitted to Tikur Anbessa Specialized hospital, Addis Ababa, Ethiopia: a cross-sectional study

BMC Neurology ◽

10.1186/s12883-019-1578-x ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Yared Zenebe Zewde ◽

Abenet Tafesse Mengesha ◽

Yeweynhareg Feleke Gebreyes ◽

Halvor Naess

Keyword(s):

Acute Stroke ◽

Cross Sectional Study ◽

Stroke Severity ◽

Sectional Study ◽

Stroke Management ◽

Stroke Patients ◽

Short Term ◽

Cross Sectional ◽

Specialized Hospital ◽

Tikur Anbessa Specialized Hospital

Abstract Background Admission hyperglycemia (HG) has been associated with worse outcomes among acute stroke patients. A better understanding and awareness of the potentially adverse influence of hyperglycemia on the clinical outcome of acute stroke patients would help to provide guidance for acute stroke management and prevention of its adverse outcomes. We aimed to assess the frequency of admission hyperglycemia and its impact on short term (30-days) morbidity and mortality outcomes of stroke in adult Ethiopian patients in an urban setting. Methods A prospective, cross-sectional study was conducted among acute stroke patients admitted to Tikur Anbessa Specialized Hospital (TASH), within 72 h of symptom onset, from July to December 2016. Socio-demographic data, neuroimaging findings and capillary blood glucose values were obtained on admission. Hyperglycemia was defined as > 140 mg/dl. National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to assess the baseline stroke severity and the 30-days post-stroke outcome, respectively. Results A total of 103 first-ever acute stroke patients were included (mean age = 55.5 + 15.3 years, 64.1% male and 65% under the age of 65 years) and 51 (49.5%) were hyperglycemic at time of admission. The median admission NIHSS score was worse in the hyperglycemic patients 14 (IQR 10–19) compared to normoglycemic patients 11 (IQR 8–15). Among stroke survivors, patients with hyperglycemia were 3.83 times (95% CI, 1.99–6.19) more likely to be functionally impaired (mRS = 3–5) at 30-days compared to normoglycemic patients (P = 0.041).Older age (≥ 65 years) (P = 0.017) and stroke severity (NIHSS > 14) (P = 0.006) at admission were both significantly associated with poor functional recovery at 30-day. Among patients who died at 30-day, two-third (66.7%) were hyperglycemic but they failed to show any significant association. Conclusions Hyperglycemia is prevalent among Ethiopian stroke patients at the time of presentation and it is associated with significantly poor functional recovery at 30th-day of follow up. This finding provides a rationale for achieving normal blood glucose in the course of acute stroke management which could have a favorable impact on the neurological outcome and quality of life for patients.

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Correlation of blood glucose levels, HbA1c, hemoglobin and leukocytes with outcome on acute stroke

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191629 ◽

2019 ◽

Vol 7 (5) ◽

pp. 1430

Author(s):

Meiriani . ◽

Yuneldi Anwar ◽

Puji Pinta Omas Sinurat

Keyword(s):

Ischemic Stroke ◽

Blood Glucose ◽

Acute Stroke ◽

Hemorrhagic Stroke ◽

Cross Sectional Study ◽

P Value ◽

Stroke Patients ◽

Cross Sectional ◽

Glucose Levels ◽

Blood Glucose Levels

Background: Diabetes and higher HbA1c level have increased the incidence of stroke. Hemoglobin levels both high and low are associated with poor outcomes. Leukocytes play an important role in the initiation of the atherosclerosis process.Methods: This was a cross-sectional study with a sample size of 62 people selected by non-random sampling method on a consecutive basis, patients with acute stroke were taken blood to measure blood glucose levels, HbA1c, Hb and Leucocytes when entering the hospital room. Outcomes were assessed using NIHSS and MRS. The calculation of NIHSS and MRS scores was performed on the first day of admission and the fourteenth day. To analyze the correlation of blood sugar levels during HbA1c, Hb and leukocytes in acute stroke, this study used Spearman's correlation test. The p value <0.05 was considered statistically significant.Results: The study subjects of 62 acute stroke patients (acute ischemic stroke 31 people and 31 people hemorrhagic stroke). Acute stroke patients were consisted of 38 men (61.3%) and 24 women (38.7%). Of 31 people with hemorrhagic stroke, there were 16 men (51.6%) and 15 women (48.4%), ischemic stroke patients were consisted of 22 people (71, 0%) and women were 9 people. Spearrman repair test showed no symptoms between blood glucose levels, HbA1c, Hemoglobin and leukocytes with outcomes in acute stroke.Conclusions: There was no significant association between blood glucose levels, HbA1c, hemoglobin and leukocytes with outcomes in acute stroke.

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Correlation between Acute Stroke and Concentration of Creatine Kinase Myocardial Band, Troponin T, Hemoglobin, and Electroyltes

Jurnal Kesehatan Masyarakat ◽

10.15294/kemas.v14i1.11846 ◽

2018 ◽

Vol 14 (1) ◽

pp. 71-80

Author(s):

Destika Fahrina ◽

Puji Pinta Sinurat ◽

Aldy Sjarifuddin Rambe

Keyword(s):

Creatine Kinase ◽

Acute Stroke ◽

Troponin T ◽

Demographic Data ◽

Cross Sectional Study ◽

Sectional Study ◽

Stroke Patients ◽

Cross Sectional ◽

The Difference ◽

Mean Concentration

Currently, there were only a few studies regarding the correlation between concentration of creatine kinase-myocardial band (CKMB), troponin T, hemoglobin, and electrolytes and acute stroke. This study aimed to understand the difference of mean concentration of CKMB, troponin T, hemoglobin, and electrolytes and their relationship with acute stroke. This was a cross sectional study using samples of 30 subjects who were selected with consecutive non random sampling. The subjects were acquired from acute stroke patients who were proven clinically and using computed tomography (CT) scan at Haji Adam Malik General Hospital. Demographic data were analyzed using descriptive statistic. The result showed that there were no difference in demographical characteristics between the subjects. In conclusion, there were no differences in mean of CKMB, troponin T, hemoglobin, and electrolytes in acute stroke. No correlation was found between acute stroke and concentration of CKMB, troponin T, hemoglobin, and electrolytes.

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Frequency of deep vein thrombosis at admission for acute stroke and associated factors: a cross-sectional study

Thrombosis Journal ◽

10.1186/s12959-021-00315-5 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Takahisa Mori ◽

Kazuhiro Yoshioka ◽

Yuhei Tanno

Keyword(s):

Acute Stroke ◽

Cross Sectional Study ◽

Sectional Study ◽

Stroke Patients ◽

Cross Sectional ◽

Vein Thrombosis ◽

Hs Crp ◽

Deep Vein ◽

D Dimer ◽

Significant Factors

Abstract Background Intermittent pneumatic compression (IPC) is commonly used to prevent deep vein thrombosis (DVT) during hospitalization in patients with acute stroke. However, if DVT exists at admission, IPC of the legs with DVT may cause migration of the thrombi, resulting in pulmonary emboli. Whole-leg ultrasonography (wl-US) is a practical tool to detect DVT; however, wl-US is not always performed at admission in all stroke patients. This retrospective cross-sectional study aimed to investigate DVT frequency and identify significant factors indicating the presence of DVT at admission for acute stroke. Methods We included patients admitted within 24 h of stroke onset between 2017 and 2019. Patients who did not undergo blood tests for D-dimer or wl-US within 72 h of arrival were excluded. We collected patient data on age; sex; anthropometric variables; presence of DVT on wl-US; and biomarkers such as D-dimer, high-sensitivity C-reactive protein (hs-CRP), and lipids. Results Of 1129 acute stroke patients, 917 met our inclusion criteria. DVT was detected in 161 patients (17.6 %). Patients with DVT were older; were more likely to be female; had lower body weight; had higher D-dimer and hs-CRP levels; had lower albumin, hemoglobin, and triglyceride levels; and had higher National Institutes of Health Stroke Scale and pre-stroke modified Rankin scale scores than patients without DVT (n = 756). In addition, multiple logistic regression analysis showed that sex (female) and D-dimer levels (≥ 1.52 µg/mL) were independent significant factors for the presence of DVT. Among 161 patients with DVT, 78 (48.4 %) had both these significant factors. Among 756 patients without DVT, 602 (79.6 %) had no or one significant factor. The odds ratio of the presence of DVT in patients with both significant factors was 6.29, using patients without any significant factors as the group for comparison. Conclusions The frequency of DVT is high in acute stroke patients at admission. Female sex and a high D-dimer level were independent significant factors for the presence of DVT. Therefore, in patients with these two significant factors at admission, IPC should be avoided or wl-US should be performed before IPC.

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Spatial Analysis of Geographic Distribution and Accessibility of Suspected Acute Stroke Patients Transferred to Acute Stroke Centers by Emergency Medical Services in Tehran, Iran: A Cross-Sectional Study

Iranian Red Crescent Medical Journal ◽

10.5812/ircmj.101502 ◽

2020 ◽

Vol 22 (7) ◽

Author(s):

Pir-Hossein Kolivand ◽

Hassanali Faraji Sabokbar ◽

Peyman Saberian ◽

Mahdi Bahmanabadi ◽

Parisa Hasani-Sharamin ◽

...

Keyword(s):

Acute Stroke ◽

Cross Sectional Study ◽

Time Of Arrival ◽

Sectional Study ◽

Stroke Patients ◽

The West ◽

Cross Sectional ◽

The Mean ◽

Stroke Center ◽

Mean Time

Objectives: We intended to map the geographical distribution of patients with acute stroke who called the Tehran EMS center based on the geographic information of the incident location on a map. The distributions of these centers and patients’ access within a standard period were evaluated. Methods: A cross-sectional study based on the registered data was conducted on suspected acute stroke patients > 18 years of age that were transferred by EMS. The analysis was performed based on pointing the patients’ locations and locating the hospitals in ArcGIS software plus a review of the polygons and focal points. Results: Totally, 1,606 patients suspected to stroke with a mean age of 64.89 ± 17.48 years were evaluated, of whom 947 (58.6%) were male. The mean time of arrival of an ambulance in the patient’s location from the EMS station was 11.94 ± 6.67 minutes, and the longest time was 69.32 minutes. The mean time from the patient’s location to the stroke center was 17.79 ± 11.42 minutes (range 2.4 - 83.70 minutes). Stroke centers in Tehran are not distributed in a balanced manner, and they are concentrated on the central and northern parts of Tehran, limiting access to hospital services. Conclusions: The multiplicity of hospitals in the west and center of Tehran led to an increase in access times in eastern Tehran. It emphasizes the necessity of revision of service locating, especially because the east of Tehran has a denser texture than the west.

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Pattern of Stroke in Diabetic and Non-Diabetic Patients Admitted at a Tertiary Care Hospital, a Cross Sectional Study

Journal of Clinical Case Reports and Studies ◽

10.31579/2690-8808/073 ◽

2021 ◽

Vol 2 (5) ◽

pp. 01-05

Author(s):

Mubashir Ahmed ◽

Sohail Ahmed Siddiqui ◽

Abdul Haq ◽

Atif Ahmed ◽

Pir Abdul Hayee ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Haemorrhagic Stroke ◽

Cross Sectional Study ◽

Care Hospital ◽

Sectional Study ◽

Stroke Patients ◽

Cross Sectional

Objective: To determine the frequency of diabetic among stroke patients and to compare the pattern of stroke in diabetic and non-diabetic stroke patients admitted at a tertiary care hospital in Hyderabad, Sindh. Methods: A cross sectional study enrolled 148 consecutive adult acute stroke patients admitted at Liaquat University Hospital, Hyderabad, during Sep 2014 to Feb 2015. Demographic, clinical, radio-imaging and laboratory data were collected on structured questionnaire to identify diabetes, type of stroke and different risk factors of stroke. Data was entered and analysed by using SPSS version 16. Association was seen by using Pearson’s Chi-square test and Independent t test. A P value of < 0.05 was considered statistically significant. Results: A total of 148 acute stroke cases were enrolled in the study. Males were 92 (62%). Mean age of study participants was 51.21 ± 10.19 years. Diabetes was found in 104 (70.3%) stroke patients. Ischemic stroke was seen in 101 (68.2%) and haemorrhagic stroke seen in 47 (31.8) stroke patients. Diabetes was more common in ischemic stroke 81 (80.2) as compared to haemorrhagic stroke 23 (48.9%) (P< 0.05). Hospital mortality of stroke patients was 37 (25%). No difference of mortality in diabetic and non-diabetic (P>0.05) stroke patients was recorded. Conclusion: Diabetes was found in majority of stroke patients. Ischemic stroke was more common than haemorrhagic stroke. Ischaemic stroke is more prevalent in diabetic whereas haemorrhagic stroke was more in non-diabetic stroke patients. Prognosis of stroke was bad in both diabetic and non-diabetic stroke patients.

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The frequency and impact of admission hyperglycemia on short term outcome of acute stroke patients admitted to Tikur Anbessa teaching hospital, Addis Ababa, Ethiopia

10.21203/rs.2.13261/v1 ◽

2019 ◽

Author(s):

Yared Zenebe Zewde ◽

Abenet Tafesse Mengesha ◽

Yeweyenhareg Feleke Gebreyes ◽

Halvor Naess

Keyword(s):

Diabetes Mellitus ◽

Blood Glucose ◽

Acute Stroke ◽

Functional Outcome ◽

Neurological Outcome ◽

Urban Setting ◽

Stroke Severity ◽

Stroke Outcome ◽

Stroke Management ◽

Stroke Patients

Abstract Background:- Although acute stroke accompanied by hyperglycemia is often associated with worse prognosis, the relationship between hyperglycemia and stroke outcome has not been studied in Ethiopian patients. As better understanding of this potentially adverse influence on stroke outcome would provide guidance for stroke management and acute care. This study aimed to determine frequency of admission hyperglycemia and its impact on thirty day functional outcome and case fatality among acute stroke patients in an urban setting in Ethiopia. Methods:- From July to December 2016, we collected information on 103 consecutive first ever acute stroke patients admitted within 72 hours of symptom onset to Tertiary hospital in Ethiopia. We obtained demographic, clinical and neuro-imaging data including capillary blood glucose at admission. National Institute of Health Stroke Scale and modified Rankin Scale were used to assess the baseline stroke severity and the degree of disability at thirty day. Results:- A total of 103 first ever acute stroke patients were enrolled with, mean age = 55.5+ 15.3 years, 64.1% male, 65% under the age of 65 years, and 31.1% were farmers by occupation . Fifty one (49.5%) patients had a documented hyperglycemia at admission with median National Institute of Health Stroke Scale score of 14 and 3(2.9%) of them were later diagnosed with diabetes mellitus. The mean modified Rankin score at 30-day was 3.6 + 1.45 while 34 (79.1%) of hyperglycemic stroke survivors scored between 3 and 5. Older age >65 years (p = 0.037), admission hyperglycemia (p = 0.04) and stroke severity (p <0.001) were significantly correlated with poor functional outcome. Conclusions:- High blood glucose on admission was significantly associated with sever disability in acute stroke patients, independent of the presence of diabetes mellitus. By establishing the negative impact of admission hyperglycemia on the neurological outcome, this study suggests that achieving normal blood glucose in the early stages of stroke could have a favorable impact on improved neurological outcome and quality of life for stroke patients. The study provides a rationale for acute stroke management that addresses the potentially adverse consequences of hyperglycemia at the time of presentation in an urban Ethiopian setting.

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Acute stroke patients’ knowledge of stroke at discharge in China: a cross-sectional study

Tropical Medicine & International Health ◽

10.1111/tmi.13148 ◽

2018 ◽

Vol 23 (11) ◽

pp. 1200-1206 ◽

Cited By ~ 4

Author(s):

Meng-Die Wang ◽

Yong Wang ◽

Ling Mao ◽

Yuan-Peng Xia ◽

Quan-Wei He ◽

...

Keyword(s):

Acute Stroke ◽

Cross Sectional Study ◽

Sectional Study ◽

Stroke Patients ◽

Cross Sectional

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Characteristics, Management, and Case-Fatality of Patients Hospitalized for Stroke with a Diagnosis of COVID-19 in France

Neuroepidemiology ◽

10.1159/000516670 ◽

2021 ◽

pp. 1-7

Author(s):

Amélie Gabet ◽

Clémence Grave ◽

Edouard Chatignoux ◽

Philippe Tuppin ◽

Yannick Béjot ◽

...

Keyword(s):

Case Fatality ◽

Cross Sectional Study ◽

Primary Diagnosis ◽

Index Hospitalization ◽

Sectional Study ◽

Stroke Patients ◽

National Hospital ◽

Cross Sectional ◽

Increased Risk ◽

Systèmes D’Information

Introduction: COVID-19 was found to be associated with an increased risk of stroke. This study aimed to compare characteristics, management, and outcomes of hospitalized stroke patients with or without a hospital diagnosis of COVID-19 at a nationwide scale. Methods: This is a cross-sectional study on all French hospitals covering the entire French population using the French national hospital discharge databases (Programme de Médicalisation des Systèmes d’Information, included in the Système National des Données de Santé). All patients hospitalized for stroke between 1 January and 14 June 2020 in France were selected. A diagnosis of COVID-19 was searched for during the index hospitalization for stroke or in a prior hospitalization that had occurred after 1 January 2020. Results: Among the 56,195 patients hospitalized for stroke, 800 (1.4%) had a concomitant COVID-19 diagnosis. Inhospital case-fatality rates were higher in stroke patients with COVID-19, particularly for patients with a primary diagnosis of COVID-19 (33.2%), as compared to patients hospitalized for stroke without COVID-19 diagnosis (14.1%). Similar findings were observed for 3-month case-fatality rates adjusted for age and sex that reached 41.7% in patients hospitalized for stroke with a concomitant primary diagnosis of COVID-19 versus 20.0% in strokes without COVID-19. Conclusion: Patients hospitalized for stroke with a concomitant COVID-19 diagnosis had a higher inhospital and 3 months case-fatality rates compared to patients hospitalized for stroke without a COVID-19 diagnosis. Further research is needed to better understand the excess of mortality related to these cases.

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