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

Abstract

BACKGROUND AND AIM: Although admission hyperglycemia has been reported to be associated with unfavorable outcomes in acute stroke, little is known about this association in sub-Saharan Africa. Therefore, the aim of the present study was to assess the prognostic significance of admission hyper-glycemia in the acute phase of stroke in Congolese patients. METHODS: In a multicenter prospective cohort study, consecutive patients with acute stroke were examined in 5 Emergency Rooms or Intensive Care Units of Kinshasa between July 15 th , 2017 and March 15 th , 2018. The severity of stroke was assessed at admission using the Glasgow Coma Scale. Stress hyperglycemia was defined as random blood glucose levels at admission > 140 mg/dL in patients without known type 2 diabetes mellitus (T2DM). The endpoint was 10-day all-cause in-hospital mortality. Survival (time-to-death) curves were built using the Kaplan Meier methods. Cox proportional analysis was used to identify predictors of 10-day all-cause in-hospital mortality. The predictive performance of blood glucose level to predict 10-day all-cause in-hospital mortality was assessed using ROC curve analysis. RESULTS: Out of 194 patients (mean age 58.7 ± 13.1 years; 64% males, 74.7% light to moderate stroke severity; 63.4% ischemic stroke) enrolled, 106 (54.6%) had admission hyperglycemia How to cite this paper: Tshituta, J.K., 666 World Journal of Cardiovascular Diseases with 77 (72.6%) having stress hyperglycemia. Ninety four deaths (48.5%); mortality rate of 6 deaths per 100 person-days (95%CI 2.7-9.3) occurred during a median follow up time 6 (5-7) days equivalent to 1542 person-days. Independent predictors of 10-day all-cause in-hospital mortality were admission hyperglycemia regardless of diabetes status (aHR 3.77; 95%CI 1.92-7.42; p < 0.001), GCS < 8 (aHR 2.87; 95%CI 1.57-5.23; p = 0.001) and non-use of mechanical ventilation (aHR 1.97; 95%CI 1.05-3.70; p = 0.034). Blood glucose concentrations (AUC 0.743; 95%CI 0.672-0.814) had a better predictive performance for 10-day all-cause in-hospital mortality with an optimal value of 154 mg/dL (sensitivity 76.6% and specificity 70%). CONCLUSION: More than half of critically ill stroke patients exhibit admission hyperglycemia that impacts negatively on their survival in the acute phase highlighting thus the need for a better blood glucose control to improve outcomes.