Prognostic Signification of Admission Hyperglycemia among Acute Stroke Patients in Intensive Care Units in Kinshasa, the Democratic Republic of the Congo
BACKGROUND AND AIM:Althoughadmission hyperglycemiahas been reported to
be associated with unfavorable outcomes in acute stroke, little is knownabout this association
in sub-Saharan Africa. Therefore, the aim of the present study was to assess
the prognostic significance of admission hyperglycemia in the acute phase of
stroke in Congolese patients.METHODS: In a multicenter prospective cohort study,consecutive patients
with acute stroke were examined in 5Emergency Rooms or
Intensive Care Units of Kinshasa between July 15th, 2017 and March 15th,
2018.The severity of stroke was assessed at admission usingthe Glasgow Coma
Scale. Stress hyperglycemiawas defined as random blood glucose levels at admission >140 mg/dL in patients without
known type 2 diabetes mellitus (T2DM). Theendpointwas 10-dayall-cause in-hospitalmortality. Survival
(time-to-death) curves were built using the Kaplan Meier methods. Cox
proportional analysis was used to identify predictors of 10-day all-cause in-hospital
mortality. The predictive performance of blood glucose level
References
[1]
Masrur, S., Cox, M., Bhatt, D., et al. (2015) Association of Acute and Chronic Hyperglycemia with Acute Ischemique Stroke Outcomes Post-Thrombolysis: Findings from Get with the Guidelines-Stroke. Journal of the American Heart Association, 4, e002193. https://doi.org/10.1161/JAHA.115.002193
[2]
Marulaiah, S., Reddy, M., Basavegowda, M., et al. (2017) Admission Hyperglycemia an Independent Predictor of Outcome in Acute Ischemic Stroke: A Longitudinal Study from a Tertiary Care Hospital in South India. Nigerian Journal of Clinical Practice, 20, 573-580. https://doi.org/10.4103/1119-3077.206368
[3]
Sung, J., Chen, C., Hsieh, Y., et al. (2017) Comparison of Admission Random Glucose, Fasting Glucose, and Glycated Hemoglobin in Predicting the Neurological Outcome of Acute Ischemic Stroke: A Retrospective Study. PeerJ, 5, e2948.
https://doi.org/10.7717/peerj.2948
[4]
Mboliasa, I., Lepira, B., Makulo, R., et al. (2015) Profil épidémiologique et clinique des urgences cardiovasculaires admises aux soins intensifs de médecine interne des Cliniques Universitaires de Kinshasa. Annals of African Medicine, 8, 1-6.
[5]
Lepira, F.B., M’Buyamba, K., Kayembe, P.K., et al. (2010) Hyperglycemia and in Hospital Mortality in Patients with Acute Stroke in Mbuji-Mayi, the Democratic Republic of Congo. Annals of African Medicine, 3, 469-477.
[6]
M’Buyamba-Kabangu, J.R., Biswika, R.T., Thijs, L., et al. (2009) In-Hospital Mortality among Black Patients Admitted for Hypertension-Related Disorders in Mbuji Mayi, Congo. American Journal of Hypertension, 22, 643-648.
https://doi.org/10.1038/ajh.2009.47
[7]
Katchunga, B.P. and Kayembe, N. (2007) Morbi-mortalité des AVC en unité des soins intensifs de la Ville Kinshasa. Congo Médical, 4, 1-5.
[8]
Mbala, M. (1994) Morbidité et mortalité hospitalières de l’adulte zairois. Panorama Médical, 5, 234-237.
[9]
WHO MONICA Project Investigators (2002) The World Health Organization (WHO) Report: 2002: Reducing Risks, Promoting Healthy Life. WHO, Geneva.
[10]
American Diabetes Association (2014) Diagnosis and Classification of Diabetes Mellitus. Diabetes Care, 37, S81-S90. https://doi.org/10.2337/dc14-S081
[11]
Ntaios, G., Egli, M., Faouzi, M., et al. (2010) J-Shaped Association between Serum Glucose and Functional Outcome in Acute Ischemic Stroke. Stroke, 41, 2366-2370.
https://doi.org/10.1161/STROKEAHA.110.592170
[12]
Bhaskar, S., Stanwell, P., Bivard, A., Spratt, N., Walker, R., Kitsos, G.H., et al. (2017) The Influence of Initial Stroke Severity on Mortality, Overall Functional Outcome and in-Hospital Placement at 90 Days Following Acute Ischemic Stroke: A Tertiary Hospital Stroke Register Study. Neurology India, 65, 1252-1259.
https://doi.org/10.4103/0028-3886.217947
[13]
Papagianni, M., Tziomalos, K., Kostaki, S., Angelopoulou, S.M., Christou, K., Bouziano, S.D., et al. (2018) Treatment with Mannitol Is Associated with Increased Risk for in-Hospital Mortality in Patients with Acute Ischemic Stroke and Cerebral Edema. American Journal of Cardiovascular Drugs, 18, 397-403.
[14]
Hong, K.S., Lee, J., Bae, H.J., Lee, J.S., Kang, D.W., Yu, K.H., et al. (2013) Greater Stroke Severity Predominates over All Other Factors for the Worse Outcome of Cardioembolic Stroke. Journal of Stroke and Cerebrovascular Diseases, 22, e373-e380. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.04.008
[15]
Fonarow, G.C., Saver, J.L., Smith, E.E., Broderick, J.P., Kleindorfer, D.O., Scco, R.L., et al. (2012) Relationship of National Institutes of Health Stroke Scale to 30-Day Mortality in Medicare Beneficiaries with Acute Ischemic Stroke. Journal of the American Heart Association, 1, 42-50. https://doi.org/10.1161/JAHA.111.000034
[16]
Capes, S.E., Hunt, D., Malmberg, K., et al. (2001) Stress Hyperglycemia and Prognosis of Stroke in Nondiabetic and Diabetic Patients: A Systematic Review. Stroke, 32, 2426-2432. https://doi.org/10.1161/hs1001.096194
[17]
Stead, L.G., Gilmore, R.M., Fernanda, B.M., et al. (2009) Hyperglycemia as an Independent Predictor of Worse Outcome in Non-Diabetic Patients Presenting with Acute Ischemic Stroke. Neurocritical Care, 10, 181-186.
https://doi.org/10.1007/s12028-008-9080-0
[18]
Raghavendra, P., Sandeep, R.A., Prabhakar, K., et al. (2016) Stress Hyperglycemia as a Prognostic Marker in Acute Ischaemic Stroke. European Journal of Pharmaceutical and Medical Research, 3, 247-256.
[19]
Snarska, K.K., Bachorzewska-Gajewska, H., Kapica-Topezewska, K., et al. (2017) Hyperglycemia and Diabetes Have Different Impacts on Outcome in Ischemic and Hemorrhagic Stroke? Archives of Medical Science, 13, 100-108.
https://doi.org/10.5114/aoms.2016.61009
[20]
Longo-Mbenza, B., Lelo Tshinkwela, M. and Mbuilu Pukuta, J. (2008) Rates and Predictors of Stroke-Associated Case Fatality in Black Central African Patients. The Cardiovascular Journal of Africa, 19, 72-76.
[21]
Kuate, T.C., Mapoure, N.Y., Gopdjim, M.L., et al. (2016) Mortalité par Accident vasculaire cérébral et ses déterminants dans un hopital de référence de Douala (Cameroun). Health Sciences and Diseases, 17, 1-6.
[22]
Owolabi, M.O., Sarfo, F., Akinyemi, R., et al. (2018) Dominant Modifiable Risk Factors for Stroke in Ghana and Nigeria (SIREN): A Case-Control Study. The Lancet Global Health, 6, e436-e446. https://doi.org/10.1016/S2214-109X(18)30002-0
[23]
Ekeh, B., Ogunniyi, A., Isamade, E. and Ekrikpo, U. (2015) Stroke Mortality and Its Predictors in a Nigerian Teaching Hospital. African Health Sciences, 15, 74-81.
https://doi.org/10.4314/ahs.v15i1.10
[24]
Adeloye, D. (2014) An Estimate of the Incidence and Prevalence of Stroke in Africa: A Systematic Review and Meta-Analysis. PLoS ONE, 9, e100724.
https://doi.org/10.1371/journal.pone.0100724.t001
[25]
Desalu, O.O., Wahab, K.W., Fawale, B., et al. (2011) A Review of Stroke Admissions at a Tertiary Hospital in Rural Southwestern Nigeria. Annals of African Medicine, 10, 80-85. https://doi.org/10.4103/1596-3519.82061
[26]
Ogbu, U.C., Westert, G.P., Slobbe, L.C.J., Arah, O.A. and Stronks, K. (2011) A Multifaceted Look at Time of Admission and Its Impact on Case-Fatality among a Cohort of Ischaemic Stroke Patients. Journal of Neurology, Neurosurgery & Psychiatry, 82, 8-13. https://doi.org/10.1136/jnnp.2009.202176
[27]
Wahab, K.W. (2008) The Burden of Stroke in Nigeria. International Journal of Stroke, 3, 290-292. https://doi.org/10.1111/j.1747-4949.2008.00217.x
[28]
Toure, K., Diagne, B.L., Seck, B.L., et al. (2010) Predictors of Stroke Mortality at the Department of Neurology, Fann University Teaching Hospital, Dakar-Senegal. African Journal of Neurological Sciences, 24, 325-334.
[29]
Gomes, J., Damasceno, A., Carrilho, C., et al. (2013) Determinants of Early Case-Fatality among Stroke Patients in Maputo, Mozambique and Impact of in-Hospital Complications. International Journal of Stroke, 8, 69-75.
https://doi.org/10.1111/j.1747-4949.2012.00957.x
[30]
Mapoure, N.Y., Tchaleu, C.B., Mbatchou, H.B., et al. (2014) Predictors of in-Hospital Mortality for Stroke in Douala, Cameroon. Stroke Research and Treatment, 2014, Article ID: 681209. https://doi.org/10.1155/2014/681209
[31]
Yao, M., Ni, J., Zhou, L., Peng, B., Zhu, Y., Cui, L., et al. (2016) Elevated Fasting Blood Glucose Is Predictive of poor out come in Non-Diabetic Stroke Patients: A Sub-Group Analysis of SMART. China. PLoS ONE, 11, e0160674.
https://doi.org/10.1371/journal.pone.0160674
[32]
Tziomalos, K., Dimitriou, P., Bouziana, S.D., et al. (2017) Stress Hyperglycemia and Acute Ischemic Stroke in-Hospital Outcome. Metabolism, 67, 99-105.
https://doi.org/10.1016/j.metabol.2016.11.011
[33]
Saxena, A., Craig, S., Anderson, C.S., Wang, X., et al. (2016) Prognostic Significance of Hyperglycemia in Acute Intracerebral Hemorrhage: The INTERACT2 Study. Stroke, 47, 682-688. https://doi.org/10.1161/STROKEAHA.115.011627
[34]
González-Moreno, E.I., Cámara-Lemarroy, C.R., González-González, J.G. and Góngora-Rivera, F. (2014) Glycemic Variability and Acute Ischemic Stroke: The Missing Link? Translational Stroke Research, 5, 638-646.
https://doi.org/10.1007/s12975-014-0365-7
[35]
Zhao, Z., Hu, J., Gao, X., et al. (2017) Hyperglycemia via Activation of Thromboxane A2 Receptor Impairs the Integrity and Function of Blood-Brain Barrier in Microvascular Endothelial Cells. Oncotarget, 8, 30030-30038.
https://doi.org/10.18632/oncotarget.16273
[36]
European Stroke Organization Executive Committee (ESOW) (2008) Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack 2008. Cerebrovascular Diseases, 25, 457507. https://doi.org/10.1159/000131083
[37]
Nardi, K., Milla, P., Eusebi, P., et al. (2012) Predictive Value of Admission Blood Glucose Level and Short-Term Mortality in Acute Cerebral Ischemia. Journal of Diabetes and Its Complications, 26, 70-76.
https://doi.org/10.1016/j.jdiacomp.2012.03.001
[38]
Jauch, E.C., Saver, J.L., Adams Jr., H.P., et al. (2013) Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Health Care Professionals from the American Heart Association/American Stroke Association. Stroke, 44, 870-947.
