An investigation of the relationship of the admission hyperglycemia to severity and 30-day outcome in acute ishemic and intracerebral hemorraghic stroke: A comparative cross sectional study

Abstract

Background: Hyperglycemia is implicated as deleterious in acute stroke, although the impact may vary by stroke subtype. We sought to determine the frequency of admission hyperglycemia (subcategorized as diabetes related or reactive) and explore the relationship to stroke severity and functional motor outcome in acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) stroke subtypes. Methods: This cross-sectional study recruited 170 stroke patients (85 AIS, 85 ICH) presenting within 72 h of onset. Baseline characteristics including stroke severity (National Institutes of Health Stroke Scale score), random blood glucose (RBG), and glycated hemoglobin (HBA1C) were documented. The outcomes were 30-day case fatality rate (CFR) and functional motor outcome. Results: The frequency of admission hyperglycemia was 24.7% in AIS and 22.4% ICH, with 18.8%/5.9% of AIS and 9.4%/12.9% of ICH presumed diabetes related and reactive, respectively. Stroke severity and infarct size were positively correlated with admission RBG and HBA1C (P = 0.000) in AIS but not ICH. Presumed mechanism of hyperglycemia did not relate significantly with either infarct size or hematoma volume (P > 0.05). Thirty days CFR was higher in AIS with hyperglycemia (42.9%) compared to normoglycemia (12.5%) (P = 0.003), but did not vary significantly in ICH (42.1% with and 36.4% without hyperglycemia; P = 0.65). There was no significant relationship of hyperglycemia to functional outcome in either stroke subtype. Conclusions: The association of admission hyperglycemia to stroke severity and short-term case fatality is evident in AIS. In ICH, hyperglycemia was not associated with significantly greater stroke severity and death at 30 days, even though case fatality was higher in those with hyperglycemia.