Original Article

Neurocritical Care

, Volume 10, Issue 2, pp 181-186

First online:

Hyperglycemia as An Independent Predictor of Worse Outcome in Non-diabetic Patients Presenting with Acute Ischemic Stroke

  • Latha G. SteadAffiliated withDivision of Research, Generose G-410, Department of Emergency Medicine, Mayo Clinic College of Medicine Email author 
  • , Rachel M. GilmoreAffiliated withDivision of Research, Generose G-410, Department of Emergency Medicine, Mayo Clinic College of Medicine
  • , M. Fernanda BellolioAffiliated withDivision of Research, Generose G-410, Department of Emergency Medicine, Mayo Clinic College of Medicine
  • , Shaily MishraAffiliated withDivision of Research, Generose G-410, Department of Emergency Medicine, Mayo Clinic College of Medicine
  • , Anjali BhagraAffiliated withDepartment of Internal Medicine, Mayo Clinic College of Medicine
  • , Lekshmi VaidyanathanAffiliated withDivision of Research, Generose G-410, Department of Emergency Medicine, Mayo Clinic College of Medicine
  • , Wyatt W. DeckerAffiliated withDepartment of Emergency Medicine, Mayo Clinic College of Medicine
  • , Robert D. BrownJrAffiliated withDepartment of Neurology, Mayo Clinic College of Medicine

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Abstract

Objective

To determine if differences in outcome exist between diabetic and non-diabetic patients who present to the Emergency Department (ED) with acute ischemic stoke (AIS) and elevated blood glucose.

Methods

The study population consisted of 447 consecutive patients who presented to the ED with AIS within 24 h of symptom onset and had blood glucose measured on presentation. Hyperglycemia was defined as >130 mg/dl. Outcomes studied included infarct volume, stroke severity (NIH Stroke Scale), functional impairment (modified Rankin Score), and 90-day mortality. Patients with hyperglycemia were then stratified into those with and without a prior history of diabetes mellitus (DM) for the purposes of analysis.

Results

Patients with hyperglycemia exhibited significantly greater stroke severity (P = 0.002) and greater functional impairment (P = 0.004) than those with normoglycemia. Patients with hyperglycemia were 2.3 times more likely to be dead at 90 days compared to those with normal glucose (P < 0.001). Stroke severity (P < 0.001) and functional impairment (P < 0.001) were both significantly worse in patients with hyperglycemia and no prior history of DM, when compared to patients with hyperglycemia and previously diagnosed DM. Among the patients without a prior history of DM, patients with hyperglycemia were 3.4 times more likely to die within 90 days (P < 0.001) when compared with patients with normoglycemia. In contrast, the hazard ratio was 1.6 among the patients with DM (P = 0.66).

Conclusion

Hyperglycemia on presentation is associated with significantly poorer outcomes following AIS. Patients with hyperglycemia and no prior history of DM have a particularly poor prognosis, worse than that for patients with known diabetes and hyperglycemia.

Keywords

Hyperglycemia Acute ischemic stroke Prognosis Diabetes mellitus