The role of hyperglycemia in acute ischemic stroke

Doctoral Dissertation uoadl:2836961 388 Read counter

Unit:
Τομέας Παθολογίας
Library of the School of Health Sciences
Deposit date:
2018-12-05
Year:
2018
Author:
Skafida Anastasia
Dissertation committee:
Δημόπουλος Μελέτιος-Αθανάσιος, Kαθηγητής, Ιατρική, ΕΚΠΑ
Μητράκου-Φαναριώτου Ασημίνα, Αναπληρώτρια Καθηγήτρια, Ιατρική, ΕΚΠΑ
Σπέγγος Κωνσταντίνος, Αναπληρωτής Καθηγητής, Ιατρική, ΕΚΠΑ
Πρωτογέρου Αθανάσιος, Aναπληρωτής Καθηγητής, Ιατρική, ΕΚΠΑ
Σταματελόπουλος Κίμων, Αναπληρωτής Καθηγητής, Ιατρική, EKΠΑ
Μανιός Ευστάθιος, Eπίκουρος Καθηγητής, Ιατρική, ΕΚΠΑ
Βασιλοπούλου Σοφία, Επίκουρη Καθηγήτρια, Ιατρική, ΕΚΠΑ
Original Title:
Η σημασία της υπεργλυκαιμίας στο οξύ ισχαιμικό εγκεφαλικό επεισόδιο
Languages:
Greek
Translated title:
The role of hyperglycemia in acute ischemic stroke
Summary:
Introduction: Variations in modiafiable physiological and biochemical parameters such as blood glucose (BG), blood pressure (BP) and body temperature (BT) after stroke have been associated with stroke outcome. However, several aspects of their impact on stroke prognosis including whether normalization is associated with improved survival, remain unclear.We aimed to assess alterations in glucose, blood pressure and temperature in acute ischaemic stroke and investigate their association with early all-cause mortality and functional outcome.

Patients and methods: We studied all consecutive acute ischaemic stroke patients admitted in 2001–2010 to the Acute Stroke Unit, at Alexandra University Hospital, in Athens. Serial measurements were performed in the first seven days post-stroke and different parameters have been estimated: mean daily values, variability, subject-specific baseline levels and rate of change in serial measurements. Cox-proportional-hazards-model analysis and logistic-regression analysis were applied to investigate the association between these parameters and all-cause mortality and functional outcome after adjustment for known confounders of stroke outcome.

Results: In 1271 patients (mean age 72.3_11.2 years), after adjusting for confounders, baseline glucose levels (HR: 1.005, 95%CI: 1.001–1.01; pΌ0.017), variability of systolic BP (SBP) as estimated by standard deviation (HR: 1.028, 95% CI: 1.01–1.048; pΌ0.005), the baseline temperature (HR: 2.758, 95%CI: 2.067–3.68; p<0.001) and the rate of temperature
change (HR: 1.841, 95%CI: 1.616–2.908; p<0.001) were independently associated with all-cause mortality within three months. Poor functional outcome was associated with subject-specific baseline values of temperature (OR: 1.743; 95%CI: 1.076–2.825; pΌ0.024), the rate of SBP (OR: 1.159; 95% CI: 1.047–1.280; pΌ0.004) and temperature change (OR: 1.402; 95% CI: 1.061–1.853; pΌ0.018).

Discussion: The main strength of our study is that we analysed simultaneously three parameters and we used four different variables for each parameter of interest.

Conclusion: Baseline glucose levels, variability of SBP and baseline temperature and its rate of change are independent predictors of all-cause mortality. Baseline values of temperature and the rate of changes in SBP and temperature are independent predictors of poor functional outcome.
Main subject category:
Health Sciences
Keywords:
Hyperglycemia, Acute ischemic stroke, Prognosis
Index:
No
Number of index pages:
0
Contains images:
Yes
Number of references:
149
Number of pages:
105
Skafida Anastasia Phd.pdf (2 MB) Open in new window