Abstract
To find out whether the high blood glucose values sometimes found in the first stage of ischemic stroke have any prognostic value, we considered 76 patients hospitalized within 24 h of an acute cerebral infarction, documented by CT brain scan and/or necropsy, whose fasting blood glucose was recorded before any treatment was given. The patients were sorted into 3 groups: diabetics, normoglycemic nondiabetics and hyperglycemic nondiabetics. On the CT findings cases with large cortical and/or subcortical infarcts were analyzed separately from those with lacunar infarcts. The clinical symptoms on admission proved to be more severe (p<0.02) and 30-day mortality higher (p<0.02) among the hyperglycemic nondiabetics, who also showed a highly significant (p<0.00001) preponderance of large cortical and subcortical infarcts over lacunar infarcts. Multivariate analysis, which took account of variables of known relevance to the prognosis of cerebral infarction (age, sex, arterial hypertension, severity of the clinical pattern, type of brain lesion), confirmed the statistically discriminant power, in terms of mortality, of belonging to the hyperglycemic nondiabetic group. The results of the study confirm that hyperglycemia at stroke onset in nondiabetic patients is an adverse prognostic factor and suggest that it may be a reaction to stress, depending on the size of the infarcted area.
Sommario
Al fine di stabilire l'eventuale significato prognostico degli elevati tassi glicemici, talora riscontrabili nelle fasi più precoci di un ictus cerebrale ischemico, sono stati presi in considerazione 76 pazienti ricoverati nelle prime 24 ore dopo un infarto cerebrale acuto, documentato con TAC del cranio e/o autopsia, la cui glicemia a digiuno è state rilevata prima dell'inizio di qualsiasi intervento terapeutico.
I pazienti sono stati divisi in 3 gruppi: diabetici, non diabetici normoglicemici e non diabetici iperglicemici. A seconda dei reperti della TAC del cranio sono stati separatamente analizzati i casi con estesi infarti corticali e/o sottocorticali e quelli con infarto lacunare.
La sintomatologia clinica all'ingresso è risultata più grave (p<0.02) e la mortalità a trenta giorni maggiore (p<0.02) nei pazienti non diabetici iperglicemici nei quali si è constatata inoltre una preponderanza altamente significativa (p<0.00001) di grossi infarti corticali e sottocorticali. L'analisi multivariata, che ha tenuto conto delle principali variabili di nota importanza per la prognosi dell'infarto cerebrale (età, sesso, ipertensione arteriosa, gravità del quadro clinico, tipo di lesione cerebrale). ha confermato il ruolo discriminante statisticamente significativo, riguardo alla mortalità, dell'appartenenza al gruppo dei non diabetici iperglicemici.
I risultati dello studio confermano il ruolo prognosticamente sfavorevole dell'iperglicemia nella fase di esordio di un infarto cerebrale nei pazienti non diabetici e suggeriscono come essa possa avere un significato di reazione allo stress in rapporto all'estensione del'area infartuata.
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Cazzato, G., Zorzon, M., Masè, G. et al. Hyperglycemia at ischemic stroke onset as prognostic factor. Ital J Neuro Sci 12, 281–288 (1991). https://doi.org/10.1007/BF02337775
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DOI: https://doi.org/10.1007/BF02337775