A Comparative Study of Clinical Profile and Outcome of Acute Ischemic Stroke with Hyperglycemia in Nondiabetic and Diabetic Patients

Abstract

Introduction & Aim: Stroke is one of the leading causes of premature death and disability in india. Diabetes mellitus by virtue of its association with micro vascular and macrovascular disease is an important risk factor in the genesis of stroke. Recently, evidence has been accumulating about the prognostic influence of hyperglycemia in patients with acute ischemic stroke, and it is becoming an important issue in stroke management. There are some studies which aims to find out course of acute ischemic stroke in diabetic patients but acute ischemic stroke patients who are non diabetic and present with hyperglycemia are less studied hence this study is planned to find out the effect of hyperglycemia in both diabetic and non diabetic acute ischemic stroke patients in terms of severity and prognosis. Material and Methods: This was observational prospective comparative study conducted over 100 acute ischemic stroke patients over a period of one year. In our study NCCT head, random blood glucose and HbA1c levels were done within 24 hours of onset of ischemic stroke. Stroke severity at presentation was determined by National Institute of Health stroke scale (NIHSS) score and functional outcome was measured at 1 week post admission and after 28 days during follow up using modified Rankin scale. Summary statistics was done by Proportion, Mean, Median and Standard Deviation. The inferential statistics was done by ANOVA and Pearson’s correlation. All measurements was done using SPSS version 21.0. ‘p’ value <0.05 was considered statistically significant. Observations and Result: In our study of 100 patients , 72 were diabetics and 28 were nondiabetics. 51 patients had blood glucose level > 199 mg/dl on admission and 49 patients had blood glucose level between 130 mg/dl to 199 mg/dl. Among diabetic patients 5.6 % had minor stroke, 34.7 % had moderate stroke, 37.5 % had moderate to severe stroke and 22.5 % had severe stroke. Among non diabetic patients 25 % had minor stroke, 42.9 % had moderate stroke , 21.4 % had moderate to severe stroke and 10.7 % had severe stroke. Among patients with glucose level > 199 mg/dl, 3.9 % had minor stroke, 31.4 % had moderate stroke, 39.2 % had moderate to severe stroke and 25. 5 % had severe stroke. Among patients with glucose level of 130-199 mg/dl, 18.4 % had minor stroke, 42.9 % had moderate stroke, 26.5 % had moderate to severe stroke and 12.2 % had severe stroke. At the end of one month diabetics and patients with higher glucose level had poor outcome. Among non diabetic patients 82 % patients had favourable prognosis and 18 % patients had unfavourable prognosis while 76 among diabetic patients 58 % patients had favourable prognosis and 42% patients had unfavourable prognosis. P value was 0.025. At the end of one month, among patients with high glucose level (i.e. >199 mg/dl) 54 % had favourable prognosis and 46 % had unfavourable prognosis while among patients with comparatively lower glucose level 75 % had favourable prognosis and 25 % had unfavourable prognosis. P value was 0.03. Conclusion:: Stroke and diabetes are major health concern in the whole world so it is the need of hour to study about clinical profile including risk factors and prognosis in patients with stroke, and diabetes being one of the most common risk factor it is necessary to study impact of diabetes and hyperglycemia on severity and prognosis of stroke. Our study concluded that diabetic patients had  more severe stroke than non diabetic patients with hyperglycemia and diabetic patients also had poor outcome than non diabetic patients with hyperglycemia. Our study also concluded that there is correlation between admission day hyperglycemia and stroke severity and its outcome. Higher glucose level on presentation are associated with more severe stroke and poor functional recovery. Hence, restoration of normoglycemia as soon as possible should be encouraged.

Keywords: Diabetes mellitus , Hyperglycaemia, Acute ischemic stroke.