A study of stress hyperglycemia and its relationship with the neurological outcome in patients presenting with acute ischemic stroke

Abstract

INTRODUCTION Stroke is a common cause of emergency admission which is associated with increased mortality, morbidity and poor quality of life. After coronary artery disease and cancer, stroke is the 3rd most common cause of death in elderly. 1 The outcome of stroke is influenced by various factors including severity, type of stroke, predisposing factors, ABSTRACT Background: Cerebrovascular accident (CVA) continues to be the most common neurological disease in the developed and developing countries. It also stands as the 3rd more common cause of death after cardiovascular disease and cancer. Stroke related burden keeps rising among the patients, their relatives and treating consultants. The neurological outcome depends on various modifiable and non-modifiable risk factors. Among the modifiable risk factors, admission (stress) hyperglycemia has a deleterious effect on the neurological outcome. It is well known by various studies that diabetic patients have more severe outcome and neurological disability after acute stroke than the non-diabetic patients. Now stress hyperglycemia is also becoming a second serious marker to affect the neurological outcome of these stroke patients. The aim was to study the blood sugar level and it`s correlation with the neurological outcome among the acute ischemic stroke patients on admission and at third month of follow-up. Methods: It is a prospective and comparative study done in a tertiary care hospital. Adult patients (> 40 years) presenting with acute ischemic stroke were neurologically stratified based on National Institutes of Health Stroke Scale (NIHSS) and admission blood sugars were noted. They were subdivided into 3 groups. Group 1 consisting of 31 normoglycemic patients, group 2 consisting of 32 stress hyperglycemic patients and group 3 consisting of 40 Type 2 diabetes mellitus (T2DM) patients. They were again reassessed after 3 months with FBS, PPBS and neurological recovery by NHISS. Chi-square test / fischer exact test was used to compare between 3 groups. A p-value of <0.005 was considered statistically significant. Results: The normoglyceamic individuals had much better functional recovery when compared with stress hyperglyceamia and diabetes mellitus groups (p <0.001) at 3 months. Conclusions: Abnormally high blood sugar at the time of presentation in acute stroke patient, significantly alter functional recovery at 3 rd month of follow-up. Hence admission blood sugar level may be used as a surrogate marker to predict functional recovery.