Fazle Elahi Nurani¹, Md. Matiur Rahman², Md. Ismail Patwary³
1. Assistant Professor, Medicine, North East Medical College Hospital, Sylhet
2. Associate Professor and Head, Neurology, MAG Osmani Medical College Hospital, Sylhet
3. Professor and Head, Medicine, MAG Osmani Medical College Hospital, Sylhet
Abstract
Objective: Several international studies have reported hyperglycaemia at patient’s admission to be an independent predictor for increased mortality and severity after ischemic stroke, as well as for increased size of cerebral ischemic lesion. However, no association between admission blood-glucose-level and stroke-outcome was also reported by others. Therefore, data regarding the effect of admission hyperglycaemia on the prognosis of ischaemic stroke in Bangladesh are desirable considering the potentially adverse but presumably modifiable nature of hyperglycaemia in acute stroke. This study was also designed to find out the short-term outcome (such as neurological improvement or deterioration) of CT-scan confirmed acute ischaemic stroke patients in relation to admission hyperglycaemia, alongside evaluating the deaths of acute ischaemic stroke patients within seven days of occurrence.
Method: All patients with acute ischemic stroke admitted during the study period (from 1st January 2009 to 31st December 2010), fulfilling the inclusion & exclusion criteria, were enrolled in this prospective type of comparative study. Sample-size was 134, and Sampling-technique was consecutive, convenient & exhaustive.
Result: Most of the patients (76.8%) were in the age-range of 50 to 79 years (n = 96) In this study, acute ischemic stroke was significantly more common among the male patients (n = 74) than among the female patients (n = 5l) Systemic arterial hypertension was present in 59.2% patients (n = 74) . Dyslipidaemia was present among 45.6% patients (n = 57) . 44.8% patients (n = 56) were smoker. Previous history of Transient Ischaemic Attack was present in 16.0% patients (n = 20) with acute ischemic stroke. Atrial fibrillation was present in 12.8% of patients (n = 16) with acute ischemic stroke. Previous history of IHD was present in 21.6% patients (n = 27) Hyperglycaemia at admission was due to undiagnosed DM in 74.4% patients (n = 93) and to other causes (stress hyperglycaemia and unexplained hyperglycaemia) in 25.6% patients (n = 32) The modified National Institutes of Health Stroke Scale (mNIHSS) score was significantly higher in the hyperglycaemic group than that of the normoglycaemic group [16.5 (SD plus/minus 6.3) vs 11.5 (SD plus/minus 5.6) ] 20.9% patients (n = 14) of the hyperglycaemic group and 6.0% patients (n = 4) of the normoglycaemic group died in the hospital by day7. Early neurological improvement was 20.8% (n = 11) for the hyperglycaemic group and 44.4% (n = 28) for the normoglycaemic group. Among the 23 patients with non-diabetic admission hyperglycaemia, 34.8% patients (n = 8) had died in hospital; while among the 44 patients with diabetic admission hyperglycaemia, 13.6% patients (n = 6) had died in hospital.
Conclusion: This study revealed that the patients with admission hyperglycaemia were 4 times more likely to die within seven days of acute ischaemic stroke as compared to admission normoglycaemia. The acute ischaemic stroke patients with admission hyperglycaemia were also 0.33 times less likely to have early neurological improvement as compared to admission normoglycaemia.