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Impact of diabetes mellitus and admission hyperglycemia on outcomes after intravenous thrombolysis in acute ischemic stroke patients

Evgeniya Kalevska, Silva Andonova, Darina Georgieva-Hristova, Tihomir Drenski

Abstract

Diabetes mellitus (DM) is a major risk factor for stroke, which is associated with unfavorable outcomeafter acute ischemic stroke (AIS) and disability. The potential harmful effect of DM, and the role and importance of blood glucose(BG) at admission are currently unclear for clinical outcome after АIS. Aim of this study is to look for correlations between the presence of DM and theinitial level of BG and the clinical outcome after an intravenous thrombolysis (IVT) in patients with acute AIS.

Material and methods. IVT with Astylise has been conducted to 170 patients with AIS for the period 09.2011- 09.2015, from which 20% (n = 34) are with DM, 80% without DM (n = 136). According to the values of the BG at admission they have been divided into three groups: I group- (n = 34) < 6,0 mmol/l; II group (n = 65) 6,1-8,0 mmol/l; III group (n = 39) > 8,1 mmol/l.

Results With mRs (0-2) at 3 months are 60.2% of patients without DM and 40% respectively, p= 0,05(OR-1,5, 95% CI 0,91-2,49). With mRs (0-1) are 35% and 24% respectively (p= 0.196). The probability of this outcome is 1.47 times higher in those without DM (OR 1,47, 95% CI: 0,7-3,09). Mortality about the third month is 20% in patients with DM and 8.8% in those without DM, p <0.05. The frequency of intracerebral hemorrhage (ICH) is similar -5.9% and 6.6% (p = 0.617). Thera is no statistically reliable dependence between the clinical outcome at 3 months and blood sugar levels in admission. With mRs (0-2) are 64.7% in the I group, 58.5% in the II group and 46.2% in the III group (p> 0.05); With mRs (0-1) are respectively 38.2%, 32.3% and 30.8% (p> 0.05). Mortality is 15.4% in the III group compared to 9.2% in the II and 8.8% in the I (p> 0.05). With mRs(3-5) are 38.4% of the III group and 26.5% in the I (p> 0.05).

Conclusion. Patients with DM have significantly higher mortality and lack of favorable functional outcome at third monthcompared to those without DM, which can not be explained by the presence of ICH. The initial HG not significantly associated with unfavorable clinical outcome, but she quickly identify patients with an increased risk of such an outcome in which blood sugar levels should be closely monitored.


Keywords

thrombolysis,ischemic stroke, hyperglycemia, diabetes mellitus

Full Text


References

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DOI: http://dx.doi.org/10.14748/ssm.v48i2.1515
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About The Authors

Evgeniya Kalevska
Medical University of Varna
Bulgaria

Silva Andonova

Darina Georgieva-Hristova

Tihomir Drenski

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