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Berehan HB, Dessie ZG, Tesfaw LM. Exploring functional abilities and competing risks among stroke patients: a longitudinal and survival analysis study at Felege Hiwot Referral Hospital, Ethiopia. BMJ Open 2024; 14:e073384. [PMID: 38697761 PMCID: PMC11086538 DOI: 10.1136/bmjopen-2023-073384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 04/15/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES This study aimed to evaluate competing risks and functional ability measures among patients who had a stroke. DESIGN A joint model comprising two related submodels was applied: a cause-specific hazard submodel for competing drop-out and stroke-related death risks, and a partial proportional odd submodel for longitudinal functional ability. SETTING Felege Hiwot Referral Hospital, Ethiopia. PARTICIPANTS The study included 400 patients who had a stroke from the medical ward outpatient stroke unit at Felege Hiwot Referral Hospital, who were treated from September 2018 to August 2021. RESULTS Among the 400 patients who had a stroke, 146 (36.5%) died and 88 (22%) dropped out. At baseline, 14% of patients had no symptoms and/or disability while 24% had slight disability, and 25% had severe disability. Most patients (37.04%) exhibited moderate functional ability. The presence of diabetes increased the cause-specific hazard of death by 3.95 times (95% CI 2.16 to 7.24) but decreased the cause-specific hazard of drop-out by 95% (aHR 0.05; 95% CI 0.01 to 0.46) compared with non-diabetic patients who had a stroke. CONCLUSION A substantial proportion of patients who had a stroke experienced mortality and drop-out during the study period, highlighting the importance of considering competing risks in stroke research. Age, diabetes, white cell count and stroke complications were significant covariates affecting both longitudinal and survival submodels. Compared with stand-alone models, the joint competing risk modelling technique offers comprehensive insights into the disease's transition pattern.
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Affiliation(s)
| | - Zelalem G Dessie
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
- Department of Statistics, Bahir Dar University, Bahir Dar, Ethiopia
| | - Lijalem Melie Tesfaw
- Department of Statistics, Bahir Dar University, Bahir Dar, Ethiopia
- Epidemiology and Biostatistics Division, The University of Queensland, Brisbane, Queensland, Australia
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Tento T, Kume A, Kumaso S. Risk factors for stroke-related functional disability and mortality at Felege Hiwot Referral Hospital, Ethiopia. BMC Neurol 2023; 23:393. [PMID: 37907867 PMCID: PMC10617073 DOI: 10.1186/s12883-023-03444-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/20/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Stroke is one of the top causes of functional disability around the world. The main objective was to identify stroke-related functional outcomes and risk factors. A good functional outcome is defined as the absence of problems secondary to the stroke event, a poor functional outcome as the presence of complications, and mortality as the existence of complications. METHOD A retrospective cohort analysis was used to observe factors in 298 eligible adult (18 or older) stroke patients who attend outpatient clinics every three months at Felege Hiwot Referral Hospital between September 2019 and August 2021 to predict outcomes. RESULT The likelihood of dying from a poor outcome was 9%, and the likelihood of recovering was 24%. The average time spent on good and poor outcomes for different levels of independent variables varies according to their risk. During the first three years of follow-up, the instantaneous risk with a 95% confidence interval of transitioning from good to poor outcome in the women, aged 60 or older, with hypertension, atrial fibrillation, and hemorrhage stroke versus men stroke patients, aged 18 to 59, without hypertension, atrial fibrillation, and ischemic stroke were 1.54 (1.10, 2.15), 1.73 (1.19, 2.52), 2.34 (1.55, 3.53), 2.74 (1.64, 4.56), and 1.52 (1.10, 2.19) respectively. The hazard ratio of transitioning from poor outcome to death for patients with diabetes mellitus and atrial fibrillation versus those without diabetes mellitus and atrial fibrillation was estimated to be 1.95 (1.10, 3.46) and 3.39 (1.67, 6.89), respectively. CONCLUSION Women over 60 with hypertension, atrial fibrillation, and hemorrhagic stroke were more likely to progress from a good to a poor outcome. Diabetes and atrial fibrillation were also risk factors for progressing from a poor outcome to death. The states and transitions, as well as a clinical control of the hazards for the transition through states, should improve the physician's decision-making process. Since gender and age are difficult to control, early intervention by patients and the hospital may be critical in influencing functional outcomes.
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Affiliation(s)
- Tegenu Tento
- Department of Statistics, College of Natural and Computational Sciences, Jinka University, Jinka, Ethiopia.
| | - Abraham Kume
- Department of Statistics, College of Natural and Computational Sciences, Jinka University, Jinka, Ethiopia
| | - Sebisibe Kumaso
- Health Monitoring and Evaluation Department, Alle Special Woreda, Kolango, Ethiopia
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Chang JY, Kim WJ, Kwon JH, Kim BJ, Kim JT, Lee J, Cha JK, Kim DH, Cho YJ, Hong KS, Lee SJ, Park JM, Lee BC, Oh MS, Lee SH, Kim C, Kim DE, Lee KB, Park TH, Choi JC, Shin DI, Sohn SI, Hong JH, Lee JS, Bae HJ, Han MK. Prestroke Glucose Control and Functional Outcome in Patients With Acute Large Vessel Occlusive Stroke and Diabetes After Thrombectomy. Diabetes Care 2021; 44:2140-2148. [PMID: 34215632 PMCID: PMC8740925 DOI: 10.2337/dc21-0271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/26/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate whether prestroke glucose control is associated with functional outcomes in patients with acute large vessel occlusive stroke and diabetes who underwent intra-arterial thrombectomy (IAT). RESEARCH DESIGN AND METHODS From the Clinical Research Center for Stroke-Korea registry, we included patients with emergent large vessel occlusive stroke with diabetes who underwent IAT between January 2009 and March 2020. The association between the HbA1c level at admission and functional outcomes (modified Rankin Scale at 3 months after the index stroke) was assessed. RESULTS A total of 1,351 patients were analyzed. Early neurological deterioration was more common in patients with higher levels of HbA1c at admission (P = 0.02 according to HbA1c quintiles, P = 0.003 according to an HbA1c cutoff value of 7.0%) than in those with lower HbA1c levels. Higher HbA1c levels at admission were significantly associated with decreased odds of favorable functional outcomes at a threshold of 7.0-7.1%. The association was consistently observed in subgroups divided according to age, sex, stroke subtype, occlusion site, degree of recanalization, thrombolysis modalities, time from symptom onset to groin puncture, and treatment period. CONCLUSIONS Prestroke glucose control with a target HbA1c of ≤7.0% may be beneficial for neurological recovery in patients with diabetes undergoing IAT for large vessel occlusive stroke, regardless of stroke subtype, bridging intravenous thrombolysis, occlusion site, degree of recanalization, and treatment period.
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Affiliation(s)
- Jun Young Chang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wook-Joo Kim
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Ji Hyun Kwon
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Hospital, Daegu, Korea
| | - Jae Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Daejeon, Korea
| | - Jong-Moo Park
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University College of Medicine, Pyeongchon, Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University College of Medicine, Pyeongchon, Korea
| | - Sang-Hwa Lee
- Department of Neurology, Hallym University College of Medicine, Pyeongchon, Korea
| | - Chulho Kim
- Department of Neurology, Hallym University College of Medicine, Pyeongchon, Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea
| | - Tae Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju, Korea
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Association of Apolipoprotein E Gene Polymorphism with Lipid Profile and Ischemic Stroke Risk in Type 2 Diabetes Mellitus Patients. J Nutr Metab 2021; 2021:5527736. [PMID: 33833872 PMCID: PMC8018876 DOI: 10.1155/2021/5527736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 01/13/2023] Open
Abstract
Background Altered lipid profiles have consistently been linked to cerebrovascular events. Ischemic stroke (IS) was a common comorbid condition established in type 2 diabetes mellitus (T2DM). The apolipoprotein E (ApoE) gene which has a notably critical function in lipoprotein metabolism is believed as one of the potential candidate genes susceptible to IS complications in T2DM. This research aimed to determine the association of apolipoprotein E gene polymorphism with lipid profile and IS risk in T2DM patients. Methods This case-control study involved a total of 60 diabetic participants divided into two groups with and without IS. ApoE was genotyped using PCR and sequencing analysis. Results The most predominant genotype observed in 27 participants (45%) was E3/E3. Lower levels of high-density lipoprotein cholesterol (HDL-C) were found in ε2 carriers (p=0.003; 95% CI -23.35--4.89) and ε4 carriers (p=0.019; 95% CI 1.38-14.55) compared to ε3 homozygotes. Total cholesterol (TC), triglyceride, and low-density lipoprotein cholesterol (LDL-C) levels had no association with ApoE gene polymorphism in this study. ApoE gene polymorphism was not related to IS in T2DM (p=0.06; adjusted OR: 4.71; 95% CI 0.93-23.79). Conclusions ApoE ε2 and ε4 carriers were associated with lower levels of HDL-C. No association was identified between ApoE gene polymorphism and IS in T2DM patients.
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Wang N, Liu Q, Liu H, Cong X, Yang H, Yu Y, Cao Y, Ma L. Association of Apolipoprotein E Polymorphisms and Risks of Ischemic Stroke in Chinese Patients with Type 2 Diabetes Mellitus. J Diabetes Res 2021; 2021:8816996. [PMID: 33490286 PMCID: PMC7801050 DOI: 10.1155/2021/8816996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/05/2020] [Accepted: 12/24/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The apolipoprotein E (APOE) gene polymorphisms have been intensively studied in patients with type 2 diabetes mellitus (T2DM) and ischemic stroke (IS) in recent years. However, it is unclear whether APOE gene polymorphisms are correlated with increased risk for developing IS in T2DM patients. Thus, this study was designed to examine the association between APOE gene polymorphisms and risks of IS in Chinese patients with T2DM. METHODS This case-control study enrolled 243 subjects with T2DM as controls, and 210 subjects with T2DM complicated with IS as case patients. The genotypes were determined using real-time PCR while HbA1c and lipid levels were detected using commercially available kits. RESULTS The systolic blood pressure (SBP), diastolic blood pressure (DBP), and the proportion of patients with a history of hypertension were higher in the case patients than that in the controls. We confirmed that the ε2/ε3 genotype, as well as SBP and history of hypertension, was the independent risk factor for developing IS in T2DM patients. CONCLUSIONS We conclude that the ε2/ε3 genotype might contribute to the increased risk for developing IS in Chinese patients with T2DM.
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Affiliation(s)
- Na Wang
- Department of Transfusion Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Qian Liu
- Clinical Laboratory, China-Japan Friendship Hospital, Beijing 100029, China
| | - Hui Liu
- Clinical Laboratory, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xiao Cong
- Clinical Laboratory, China-Japan Friendship Hospital, Beijing 100029, China
| | - Hui Yang
- Clinical Laboratory, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yang Yu
- Clinical Laboratory, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yongtong Cao
- Department of Transfusion Medicine, China-Japan Friendship Hospital, Beijing 100029, China
- Clinical Laboratory, China-Japan Friendship Hospital, Beijing 100029, China
| | - Liang Ma
- Clinical Laboratory, China-Japan Friendship Hospital, Beijing 100029, China
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Association of pre- and post-stroke glycemic status with clinical outcome in spontaneous intracerebral hemorrhage. Sci Rep 2019; 9:19054. [PMID: 31836800 PMCID: PMC6911072 DOI: 10.1038/s41598-019-55610-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/09/2019] [Indexed: 01/04/2023] Open
Abstract
In this study, we aimed to disclose the association of pre- and post-stroke glycemic status with clinical outcome in patients with spontaneous intracerebral hemorrhage (sICH). It was a multicenter, prospective, observational cohort study, conducted in 13 hospitals in Beijing from January 2014 to September 2016. The association of admission random blood glucose (RBG), fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) with clinical outcome at 90 days after sICH onset were analyzed comprehensively. Poor outcome was defined as death or modified Rankin Scale (mRS) score >2. The results showed that elevated RBG and FBG were associated with larger hematoma volume, lower GCS, higher NIHSS (P < 0.001), and poor outcome, but HbA1c was not (P > 0.05). In stratified analysis, the association of poor outcome with elevated FBG or RBG retained statistical significance just in patients without diabetes. Kaplan-Meier curve and Cox regression showed that patients with elevated FBG or RBG had significantly higher risk of death within 90 days (P < 0.05). So we conclude that poststroke hyperglycemia was associated with larger hematoma volume, severe neurological damage and poor clinical outcome, but HbA1c was not relevant to hematoma volume or clinical outcome in patients with sICH.
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Ma S, Wang J, Wang Y, Dai X, Xu F, Gao X, Johnson J, Xu N, Leak RK, Hu X, Luo Y, Chen J. Diabetes Mellitus Impairs White Matter Repair and Long-Term Functional Deficits After Cerebral Ischemia. Stroke 2019; 49:2453-2463. [PMID: 30355111 DOI: 10.1161/strokeaha.118.021452] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background and Purpose- Type 2 diabetes mellitus (T2DM) is a major comorbidity that exacerbates ischemic brain injury and worsens functional outcome after stroke. T2DM is known to aggravate white matter (WM) impairment, but the underlying mechanism is not completely understood. This study was designed to test the hypothesis that T2DM impedes poststroke WM recovery by suppressing both oligodendrogenesis and beneficial microglia/macrophage responses. Methods- Permanent distal middle cerebral artery occlusion was performed in wild-type, homozygous diabetic db/db, and heterozygous db/+ mice. The adhesive removal, open field, and Morris water maze tests were used to assess neurobehavioral outcomes. Neuronal tissue loss, WM damage, oligodendrogenesis, and microglia/macrophage responses were evaluated up to 35 days after stroke. The functional integrity of WM was measured by electrophysiology. Primary microglia-oligodendrocyte cocultures were used for additional mechanistic studies. Results- T2DM exacerbated structural damage and impaired conduction of compound action potentials in WM 35 days after stroke. The deterioration in WM integrity correlated with poor sensorimotor performance. Furthermore, T2DM impaired the proliferation of oligodendrocyte precursor cells and the generation of new myelinating oligodendrocytes. T2DM also promoted a shift of microglia/macrophage phenotype toward the proinflammatory modality. Coculture studies confirmed that microglia/macrophage polarization toward the proinflammatory phenotype under high glucose conditions suppressed oligodendrocyte precursor cell differentiation. Conclusions- Deterioration of WM integrity and impairments in oligodendrogenesis after stroke are associated with poor long-term functional outcomes in experimental diabetes mellitus. High glucose concentrations may shift microglia/macrophage polarization toward a proinflammatory phenotype, significantly impairing oligodendrocyte precursor cell differentiation and WM repair.
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Affiliation(s)
- Shubei Ma
- From the Institute of Cerebrovascular Disease Research and Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China (S.M., Y.L.).,Pittsburgh Institute of Brain Disorders and Recovery, and Department of Neurology, University of Pittsburgh School of Medicine, PA (S.M., J.W., Y.W., X.D., F.X., X.G., J.J., N.X., X.H., J.C.)
| | - Jianyi Wang
- Pittsburgh Institute of Brain Disorders and Recovery, and Department of Neurology, University of Pittsburgh School of Medicine, PA (S.M., J.W., Y.W., X.D., F.X., X.G., J.J., N.X., X.H., J.C.)
| | - Yanling Wang
- Pittsburgh Institute of Brain Disorders and Recovery, and Department of Neurology, University of Pittsburgh School of Medicine, PA (S.M., J.W., Y.W., X.D., F.X., X.G., J.J., N.X., X.H., J.C.)
| | - Xuejiao Dai
- Pittsburgh Institute of Brain Disorders and Recovery, and Department of Neurology, University of Pittsburgh School of Medicine, PA (S.M., J.W., Y.W., X.D., F.X., X.G., J.J., N.X., X.H., J.C.)
| | - Fei Xu
- Geriatric Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, PA (F.X., X.H., J.C.).,Pittsburgh Institute of Brain Disorders and Recovery, and Department of Neurology, University of Pittsburgh School of Medicine, PA (S.M., J.W., Y.W., X.D., F.X., X.G., J.J., N.X., X.H., J.C.)
| | - Xuguang Gao
- Pittsburgh Institute of Brain Disorders and Recovery, and Department of Neurology, University of Pittsburgh School of Medicine, PA (S.M., J.W., Y.W., X.D., F.X., X.G., J.J., N.X., X.H., J.C.)
| | - Joycelyne Johnson
- Pittsburgh Institute of Brain Disorders and Recovery, and Department of Neurology, University of Pittsburgh School of Medicine, PA (S.M., J.W., Y.W., X.D., F.X., X.G., J.J., N.X., X.H., J.C.)
| | - Na Xu
- Pittsburgh Institute of Brain Disorders and Recovery, and Department of Neurology, University of Pittsburgh School of Medicine, PA (S.M., J.W., Y.W., X.D., F.X., X.G., J.J., N.X., X.H., J.C.)
| | - Rehana K Leak
- Graduate School of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA (R.K.L.)
| | - Xiaoming Hu
- Geriatric Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, PA (F.X., X.H., J.C.).,Pittsburgh Institute of Brain Disorders and Recovery, and Department of Neurology, University of Pittsburgh School of Medicine, PA (S.M., J.W., Y.W., X.D., F.X., X.G., J.J., N.X., X.H., J.C.)
| | - Yumin Luo
- From the Institute of Cerebrovascular Disease Research and Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China (S.M., Y.L.)
| | - Jun Chen
- Geriatric Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, PA (F.X., X.H., J.C.).,Pittsburgh Institute of Brain Disorders and Recovery, and Department of Neurology, University of Pittsburgh School of Medicine, PA (S.M., J.W., Y.W., X.D., F.X., X.G., J.J., N.X., X.H., J.C.)
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Prospective study on clinical characteristics of Japanese diabetic patients with chronic limb-threatening ischemia presenting Fontaine stage IV. Diabetol Int 2019; 11:33-40. [PMID: 31950002 DOI: 10.1007/s13340-019-00399-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 06/10/2019] [Indexed: 12/24/2022]
Abstract
The aim of this prospective cross-sectional study was to reveal clinical characteristics of Japanese diabetic patients with chronic limb-threatening ischemia (CLTI) presenting ischemic unhealed ulcer/gangrene (Fontaine stage IV) in the real-world settings. The present study included 132 Japanese diabetic patients who underwent endovascular therapy for CLTI presenting Fontaine stage IV. The prevalence of diabetes-related complications, as well as prior history of ankle-brachial index (ABI) measurement before CLTI onset, was evaluated adopting multiple imputation (50 times). Duration of diabetes was referred to as time from diagnosis. The patients were aged 70 ± 10 years, with duration of diabetes 23 ± 12 years. The diabetes-related complications were so common that only 17% (95% confidence interval: 11-24%) and 25% (17-33%) of the population were free from advanced micro- and macroangiopathies, respectively. The clustering of advanced macroangiopathies was not significantly associated with duration of diabetes (P = 0.62). On the other hand, that of advanced microangiopathies was significantly positively associated with duration of diabetes (P = 0.004). However, even in patients with duration of diabetes < 10 years, as many as 63% (38-87%) of patients had at least one advanced microangiopathy. Only 31% (22-39%) of the patients had prior history of ABI measurement before CLTI onset. The history was inversely associated with age (P = 0.005). In conclusion, the advanced diabetes-related complications were highly prevalent, even in those whose diabetes was diagnosed less than a decade before. In addition, only a few patients had ever undergone ABI measurement before CLTI onset.
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Tu Y, Guo C, Song F, Huo Y, Geng Y, Guo M, Bao H, Wu X, Fan W. Mild hypothermia alleviates diabetes aggravated cerebral ischemic injury via activating autophagy and inhibiting pyroptosis. Brain Res Bull 2019; 150:1-12. [PMID: 31082455 DOI: 10.1016/j.brainresbull.2019.05.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/26/2019] [Accepted: 05/07/2019] [Indexed: 12/20/2022]
Abstract
Diabetic patients manifest with more severe neurological deficits than non-diabetes after ischemic stroke. It has been shown that hypothermia has neuroprotective effects on cerebral ischemia, but whether it is effective for cerebral ischemia in diabetic patients remains unknown. The aim of this study was to investigate whether hypothermia can alleviate cerebral ischemic injury in diabetic rats and the regulation of autophagy and pyroptosis of the treatment. We introduced permanent middle cerebral artery occlusion (pMCAO) in a model of type 2 diabetic rats prepared by high-fat diet combined with intraperitoneal injection of STZ in vivo and mimicked cerebral ischemia with diabetes by employing high glucose stimulation and oxygen-glucose deprivation/reoxygenation (OGD/R) in vitro. Moreover, 3-methyladenine and bafilomycin A1 were used to evaluate the association between autophagy and pyroptosis in vitro. Our results showed that diabetes aggravated neurological deficits, increased the volume of cerebral infarction and brain edema as well as the blood brain barrier permeability after cerebral ischemia, which were alleviated by mild hypothermia. Compared with the pMCAO model in non-diabetic rats and OGD/R model without high glucose stimulation in vitro, the expression of P62, NOD-like receptor protein 3 (NLRP3), cleaved caspase-1 and Gasdermin-N increased and the ratio of microtubule-associated protein 1 light chain 3B (LC3B) Ⅱ/Ⅰ decreased in the pMCAO model in diabetic rats and OGD/R model with high glucose stimulation, which could be reversed by mild hypothermia. In conclusion, mild hypothermia alleviated diabetes aggravated cerebral ischemic injury via activating autophagy and inhibiting pyroptosis.
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Affiliation(s)
- Yanling Tu
- Department of Neurology, Zhongshan Hospital, Fudan University, 20032, Shanghai, China
| | - Cen Guo
- Department of Neurology, Zhongshan Hospital, Fudan University, 20032, Shanghai, China
| | - Feifei Song
- Department of Neurology, Zhongshan Hospital, Fudan University, 20032, Shanghai, China
| | - Yajing Huo
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 200437, Shanghai, China
| | - Yang Geng
- Department of Neurology, Zhongshan Hospital, Fudan University, 20032, Shanghai, China
| | - Mingwei Guo
- Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Dongchuan Road 500, Shanghai, 200241, China
| | - Haifeng Bao
- Department of Neurology, Zhongshan Hospital, Fudan University, 20032, Shanghai, China
| | - Xuqing Wu
- Department of Neurology, Zhongshan Hospital, Fudan University, 20032, Shanghai, China.
| | - Wei Fan
- Department of Neurology, Zhongshan Hospital, Fudan University, 20032, Shanghai, China.
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Takahara M, Iida O, Fujita Y, Haneda M. Clinical characteristics of Japanese diabetic patients with critical limb ischemia presenting Fontaine stage IV. Diabetol Int 2018; 10:231-235. [PMID: 31275791 DOI: 10.1007/s13340-018-0387-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
The aim of the current study was to reveal the clinical characteristics of Japanese diabetic patients with critical limb ischemia (CLI) presenting ischemic unhealed ulcer/gangrene (Fontaine stage IV) in the real-world settings. The current retrospective cross-sectional study included consecutive 282 Japanese diabetic patients who underwent endovascular therapy for CLI presenting Fontaine stage IV. The prevalence of diabetes-related complications was estimated adopting multiple imputation (50 times). The patients were aged 70 ± 10 years. Median duration of diabetes was 21 (interquartile range 12-31) years. The prevalence of proliferative diabetic retinopathy, end-stage renal disease on regular dialysis, stroke, coronary artery disease, and chronic heart failure was estimated at 48% (95% confidence interval 39-56%), 52% (46-58%), 34% (28-39%), 48% (42-54%), and 35% (29-41%), respectively. The prevalence of stroke, coronary artery disease, and chronic heart failure was not significantly associated with the duration of diabetes (all p > 0.05). On the other hand, the prevalence of proliferative diabetic retinopathy and end-stage renal disease on regular dialysis was significantly positively associated with the duration of diabetes (both p < 0.05). However, these prevalences reached as high as ~ 30% even in patients with duration of diabetes < 10 years. In conclusion, the advanced stage of diabetes-related complications was prevalent in patients with CLI presenting Fontaine stage IV.
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Affiliation(s)
- Mitsuyoshi Takahara
- 1Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Osamu Iida
- 2Cardiovascular Center, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511 Japan
| | - Yukihiro Fujita
- 3Division of Metabolism and Biosystemic Science, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510 Japan
| | - Masakazu Haneda
- 3Division of Metabolism and Biosystemic Science, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510 Japan
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Efficacy of High-Dose and Low-Dose Simvastatin on Vascular Oxidative Stress and Neurological Outcomes in Patient with Acute Ischemic Stroke: A Randomized, Double-Blind, Parallel, Controlled Trial. Neurol Res Int 2018; 2018:7268924. [PMID: 29850244 PMCID: PMC5932464 DOI: 10.1155/2018/7268924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/26/2018] [Accepted: 03/13/2018] [Indexed: 12/18/2022] Open
Abstract
Backgrounds Stroke is the leading cause of death and long-term disability. Oxidative stress is elevated during occurrence of acute ischemic stroke (AIS). Soluble LOX-1 (sLOX-1) and NO are used as biomarkers for vascular oxidative stress that can reflect stabilization of atherosclerotic plaque. Previous study showed that simvastatin can reduce oxidative stress and LOX-1 expression. Objectives To evaluate neurological outcomes and serum sLOX-1 and NO levels in patients with AIS treatment with low dose 10 mg/day and high dose 40 mg/day of simvastatin. Methods 65 patients with AIS within 24 hours after onset were randomized to treatment with simvastatin 10 mg/day or 40 mg/day for 90 days. Personal data and past history of all patients were recorded at baseline. The blood chemistries were measured by standard laboratory techniques. Serum sLOX-1 and NO levels and neurological outcomes including NIHSS, mRS, and Barthel index were tested at baseline and Day 90 after simvastatin therapy. Results Baseline characteristics were not significantly different in both groups except history of hypertension. Serum sLOX-1 and NO levels significantly reduce in both groups (sLOX-1 = 1.19 ± 0.47 and 0.98 ± 0.37 ng/ml; NO = 49.28 ± 7.21 and 46.59 ± 9.36 μmol/l) in 10 mg/day and 40 mg/day simvastatin groups, respectively. Neurological outcomes including NIHSS, mRS, and Barthel index significantly improve in both groups. However, no difference in NO level and neurological outcomes was found at 90 days after treatment as compared between low dose 10 mg/day and high dose 40 mg/day of simvastatin. Conclusion High-dose simvastatin might be helpful to reduce serum sLOX-1. But no difference in clinical outcomes was found between high- and low-dose simvastatin. Further more intensive clinical trial is needed to confirm the appropriate dosage of simvastatin in patients with acute ischemic stroke. This trial is registered with ClinicalTrials.gov ID: NCT03402204.
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Luitse MJ, Velthuis BK, Kappelle LJ, van der Graaf Y, Biessels GJ. Chronic hyperglycemia is related to poor functional outcome after acute ischemic stroke. Int J Stroke 2016; 12:180-186. [PMID: 27784821 DOI: 10.1177/1747493016676619] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Acute hyperglycemia is associated with poor functional outcome after ischemic stroke, but the association between chronic antecedent hyperglycemia and outcome is unclear. Aim We assessed the association between chronic hyperglycemia, measured by hemoglobin A1c, and functional outcome in patients with acute ischemic stroke. Methods We included 812 patients with acute ischemic stroke (mean age 66 ± 14 years; 61.5% male). Patients were categorized per hemoglobin A1c level: no (<39 mmol/mol), moderate (39-42 mmol/mol), or severe chronic hyperglycemia (>42 mmol/mol). Poor functional outcome was defined as modified Rankin Scale score > 2 after 3 months. The relation between chronic hyperglycemia and functional outcome was assessed with a Poisson regression analysis and expressed as risk ratios with 95% confidence intervals with no chronic hyperglycemia as the reference. Results Moderate chronic hyperglycemia was present in 234 (28.8%) patients and severe chronic hyperglycemia in 183 (22.5%) patients. Acute hyperglycemia on admission was present in 338 (41.6%) patients. Severe chronic hyperglycemia was associated with poor outcome (risk ratios 1.40; 95% confidence interval 1.09-1.79). After adjustment for age, sex, stroke severity, vascular risk factors, and acute hyperglycemia on admission the risk ratios was 1.35 (95% confidence interval 1.04-1.76). Moderate chronic hyperglycemia was not associated with poor outcome (risk ratios 1.12; 95% confidence interval 0.87-1.44). Conclusion Severe chronic hyperglycemia is associated with poor functional outcome in patients with acute ischemic stroke. This association is independent of hyperglycemia in the acute stage of stroke and of an unfavorable vascular risk factor profile.
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Affiliation(s)
- Merel Ja Luitse
- 1 Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Birgitta K Velthuis
- 2 Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Jaap Kappelle
- 1 Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yolanda van der Graaf
- 3 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert Jan Biessels
- 1 Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Zietemann V, Wollenweber FA, Bayer-Karpinska A, Biessels GJ, Dichgans M. Peripheral glucose levels and cognitive outcome after ischemic stroke-Results from the Munich Stroke Cohort. Eur Stroke J 2016; 1:51-60. [PMID: 31008267 DOI: 10.1177/2396987316631674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/19/2016] [Indexed: 01/04/2023] Open
Abstract
Introduction The relationship between glucose metabolism and stroke outcome is likely to be complex. We examined whether there is a linear or non-linear relationship between glucose measures in the acute phase of stroke and post-stroke cognition, and whether altered glucose metabolism at different time intervals (long- and short-term before stroke, acute phase) is associated with cognitive outcome. Patients and methods In all, 664 consecutively recruited patients with acute ischemic stroke and without pre-stroke dementia were included in this prospective observational study. Blood samples were taken at admission and fasting on the first morning after stroke. Duration of diabetes was assessed by interview. Cognitive outcome was assessed by the Telephone Interview for Cognitive Status 3 months post-stroke. Dose-response analyses were used to investigate non-linearity. Regression analyses were stratified by diabetes status and adjusted for relevant confounders. Results Cognitive status was testable in 422 patients (81 with diabetes). There was a non-linear relationship between both admission and fasting glucose levels and cognitive outcome. Lower glucose values were significantly associated with lower Telephone Interview for Cognitive Status scores 3 months post-stroke in patients without diabetes with a similar trend in diabetic patients. There was an inverse association between duration of diabetes and Telephone Interview for Cognitive Status scores (linear regression: -0.10 (95% confidence interval: -0.17 to -0.02) per year increase of diabetes duration), whereas HbA1c was not related to cognitive outcome. Results were supported by sensitivity analyses accounting for attrition. Conclusion Lower glucose levels in the acute phase of stroke are associated with worse cognitive outcome but the relationship is non-linear. Long-term abnormalities in glucose metabolism are also related to poor outcome but this is not the case for shorter term abnormalities. Altered glucose levels at different stages of stroke may affect stroke outcome through different pathways.
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Affiliation(s)
- Vera Zietemann
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany
| | - Frank Arne Wollenweber
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany
| | - Anna Bayer-Karpinska
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Ni J, Yao M, Zhou L, Zhu Y, Peng B, Cui L. A guideline-based program may improve the outcome of stroke among illiterate patients. Int J Stroke 2016; 11:332-7. [PMID: 26780948 DOI: 10.1177/1747493015626151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 11/24/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Education level is considered as an important factor for post-stroke functional outcome. Our previous study confirms the feasibility of SMART program to improve adherence of secondary stroke prevention in China. AIMS We aim to investigate whether this program can influence the impact of educational level on post-stroke functional outcome in this sub-group analysis of SMART study. METHODS We enrolled 3722 patients with acute ischemic stroke from multicenter (n = 47) SMART cohort. Patient's educational level was categorized as three: illiterate, 6th grade or lower, and 7th grade or higher. Functional outcome at six-month post-stroke was assessed by Modified Rankin Scale (mRS) and categorized as favorable (mRS: 0-2) or poor (mRS: 3-5). Binary logistic model, adjusting for age, gender, stroke history, hypertension, diabetes, hyperlipidemia, educational level, and NIHSS was performed, respectively, in SMART group and usual care group to evaluate the effect of the SMART program on stroke functional outcome among different educated patients. RESULTS In both groups, logistic regression analysis showed that poor functional outcome was independently associated with older age [OR(95% CI):1.81(1.41-2.33), p < 0.001(SMART); OR (95% CI):1.38 (1.09-1.73), p = 0.007(usual care)], higher baseline NIHSS [OR (95% CI): 2.90 (2.38-3.53), p < 0.001(SMART); OR (95% CI): 2.82 (2.32-3.44), p < 0.001(usual care)], and diabetes [OR(95% CI):1.88 (1.18-3.00), p = 0.008(SMART); OR (95%CI):1.68 (1.03-2.73), p = 0.037(usual care)]. Compared to illiterate, higher educational levels were independently associated with favorable outcome in usual care group [OR (95% CI): 0.43 (0.20-0.93), p = 0.032 (6th grade or lower) and OR (95% CI): 0.40 (0.19-0.84), p = 0.016 (7th Grade or higher)], but not in SMART group (p = 0.806 and p = 0.889, respectively). CONCLUSIONS This study demonstrates that implementation of SMART program may improve post-stroke functional outcome among illiterate. This suggests special attention should be paid to illiterate patients with intensive education in order to improve post-stroke disability.
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Affiliation(s)
- Jun Ni
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Ming Yao
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Lixin Zhou
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yicheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China Neuroscience center, Chinese Academy of Medical Sciences, Beijing 100730, China
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Cruz-Herranz A, Fuentes B, Martínez-Sánchez P, Ruiz-Ares G, Lara-Lara M, Sanz-Cuesta B, Díez-Tejedor E. Is diabetes an independent risk factor for in-hospital complications after a stroke? ?. J Diabetes 2015; 7:657-63. [PMID: 25266170 DOI: 10.1111/1753-0407.12222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 08/01/2014] [Accepted: 09/20/2014] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Patients with diabetes mellitus (DM) are more likely to develop in-hospital complications (IHCs) than patients without DM. In addition, they have poorer outcomes after an ischemic stroke (IS). Our goal was to evaluate whether the increase in risk for the development of IHCs in patients with IS is due to DM per se, to poor metabolic control of the DM or to glucose levels on admission. METHODS An observational study that included 1137 consecutive IS patients admitted to a stroke unit. Demographic data, vascular risk factors, stroke severity, on-admission glycemia and IHC were compared between patients with and without DM. Multivariate logistic regression analyses were performed to identify factors associated with IHCs. RESULTS Of all included patients, 283 (24.8%) had a previous diagnosis of DM. These patients were older and had higher comorbidity, with no differences in stroke severity. They presented on-admission glycemia ≥155 mg/dL more often and suffered IHCs more frequently (24% versus 17.7%, P = 0.034). However, after adjusting for baseline differences, DM was not associated with the development of any IHC, whereas on-admission glycemia ≥155 mg/dL (odds ratio: 1.959; 95% CI 1.276-3.009; P = 0.002) and stroke severity (odds ratio: 1.141; 95% CI 1.109-1.173; P < 0.001) were the primary predictors of the development of IHCs. CONCLUSIONS Although IS patients with DM more often suffered IHCs, previous diagnosis of DM is not per se associated with the risk of IHCs. Stroke severity and on-admission glycemia ≥155 mg/dL were the most significant predictors for the development of IHCs.
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Affiliation(s)
- Andrés Cruz-Herranz
- Department of Neurology and Stroke Center, La Paz University Hospital, IdiPAZ Health Research Institute, Autonomous University of Madrid, Madrid, Spain
| | - Blanca Fuentes
- Department of Neurology and Stroke Center, La Paz University Hospital, IdiPAZ Health Research Institute, Autonomous University of Madrid, Madrid, Spain
| | - Patricia Martínez-Sánchez
- Department of Neurology and Stroke Center, La Paz University Hospital, IdiPAZ Health Research Institute, Autonomous University of Madrid, Madrid, Spain
| | - Gerardo Ruiz-Ares
- Department of Neurology and Stroke Center, La Paz University Hospital, IdiPAZ Health Research Institute, Autonomous University of Madrid, Madrid, Spain
| | - Manuel Lara-Lara
- Department of Neurology and Stroke Center, La Paz University Hospital, IdiPAZ Health Research Institute, Autonomous University of Madrid, Madrid, Spain
| | - Borja Sanz-Cuesta
- Department of Neurology and Stroke Center, La Paz University Hospital, IdiPAZ Health Research Institute, Autonomous University of Madrid, Madrid, Spain
| | - Exuperio Díez-Tejedor
- Department of Neurology and Stroke Center, La Paz University Hospital, IdiPAZ Health Research Institute, Autonomous University of Madrid, Madrid, Spain
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Liu A, Carmichael KA, Schallom ME, Riley MJ, Klinkenberg WD. Detecting and Managing Diabetes Mellitus and Prediabetes in Patients With Acute Stroke. DIABETES EDUCATOR 2015; 41:592-8. [PMID: 26246595 DOI: 10.1177/0145721715599267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE The purpose of the study was to determine the prevalence of undiagnosed diabetes mellitus (DM) and prediabetes (pre-DM) in acute stroke patients, to evaluate recommendations of diabetes treatment and follow-up care in a hospital setting, and to examine 1-year readmission rates based on admission A1C measure. METHODS This retrospective study comprised 200 patients randomly selected from 1095 patients admitted with an acute stroke and an A1C measurement during admission. DM and pre-DM prevalence levels were determined per A1C level. Recommendations for diabetes treatment during and after hospitalization were assessed; charts were reviewed for readmission. RESULTS Among 200 patients, 43% had known DM, and 0.5% had pre-DM. Among 113 patients without history of DM or pre-DM, 61.9% had A1C 5.7% to 6.4% (39-46 mmol/mol), and 8.8% had A1C ≥6.5% (48 mmol/mol). None of the newly diagnosed pre-DM and 60% of newly diagnosed DM were documented. Only 7 of newly diagnosed DM or pre-DM patients received diabetes education. For patients with known DM and A1C ≥7.0% (53 mmol/mol), 40.5% registered no change of diabetic regimen. Few patients were recommended for diabetes follow-up care. Patients with A1C ≥6.5% or <5.7% were more likely to be readmitted for any reason within 1 year (33.3% and 31.6%, respectively) than patients with A1C levels of 5.7% to 6.4% (16.5%). CONCLUSIONS The majority of acutely admitted stroke patients without known DM or pre-DM had A1C ≥5.7%. Newly diagnosed DM or pre-DM patients received inadequate diabetes education and follow-up care. These findings provide significant opportunities for improving acute stroke management.
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Affiliation(s)
- Aiqun Liu
- Diabetes Education Service, Barnes-Jewish Hospital, St Louis, MO (Ms Liu, Ms Riley)
| | - Kim A Carmichael
- Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St Louis, MO (Dr Carmichael)
| | - Marilyn E Schallom
- Department of Research for Patient Care Services, Barnes-Jewish Hospital, St Louis, MO (Dr Schallom, Dr Klinkenberg)
| | - Martha J Riley
- Diabetes Education Service, Barnes-Jewish Hospital, St Louis, MO (Ms Liu, Ms Riley)
| | - W Dean Klinkenberg
- Department of Research for Patient Care Services, Barnes-Jewish Hospital, St Louis, MO (Dr Schallom, Dr Klinkenberg)
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Prestroke glycemic status is associated with the functional outcome in spontaneous intracerebral hemorrhage. Neurol Sci 2015; 36:927-34. [PMID: 25560535 DOI: 10.1007/s10072-014-2057-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 12/27/2014] [Indexed: 10/24/2022]
Abstract
Admission hyperglycemia is thought to be related to poor neurological function and high mortality in patients with spontaneous intracerebral hemorrhage (sICH). However, it is not known whether prestroke glycemic status affects functional outcome of sICH. The study was aimed to disclose the association between prestroke glycemic status and outcome in patients with sICH. The study included 288 patients with sICH. Prestroke glycemic status was represented by hemoglobin A1c (HbA1c) values measured the next day after admission. Correlations between HbA1c and age, hematoma volume, NIHSS, and mRS were analyzed using Spearman's correlation analysis. Patients were categorized into two groups according to hematoma volume (≤25 mL or >25 mL), mRS values (≤2 or >2), or hematoma location (lobar hematoma or deep hematoma). Logistic regression analyses were used to determine the relative independent risk factors for hematoma volume, hematoma location, and mRS values. In patients with sICH, HbA1c was significantly correlated with hematoma volume, NIHSS, and mRS. High HbA1c levels were independently associated with large hematoma volume, deep ICH, and poor outcome. When patients were stratified by history of diabetes, the predictive effect of HbA1c on outcomes was only observed in patients with diabetes. Admission glucose was also related to hematoma volume, but failed to predict outcome. Although both admission glucose and HbA1c independently predicted hematoma volume in patients with sICH, HbA1c alone could serve as a better predictor of poor outcome in diabetic patients after sICH.
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18
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Affiliation(s)
- A H V Schapira
- Department of Clinical Neurosciences, UCL Institute of Neurology, London, UK.
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The role of prestroke glycemic control on severity and outcome of acute ischemic stroke. Stroke Res Treat 2014; 2014:694569. [PMID: 25295219 PMCID: PMC4175748 DOI: 10.1155/2014/694569] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 08/07/2014] [Accepted: 08/08/2014] [Indexed: 12/18/2022] Open
Abstract
Background/Aim. Relatively few studies have investigated the association of prestroke glycemic control and clinical outcome in acute ischemic stroke (IS) patients, regardless of presence of diabetes mellitus (DM). The aim of this study was to investigate the importance of prestroke glycemic control on survival, stroke severity, and functional outcome of patients with acute IS. Methods. We performed a retrospective survival analysis of 501 patients with IS admitted to Sahlgrenska University Hospital from February 15, 2005, through May 31, 2009. The outcomes of interest were acute and long-term survival; the stroke severity (NIHSS) and the functional outcome, mRS, at 12 months. Results. HbA1c was a good predictor of acute (HR 1.45; CI, 1.09 to 1.93, P = 0.011) and long-term mortality (HR 1.29; CI 1.03 to 1.62; P = 0.029). Furthermore, HbA1c >6% was significantly correlated with acute stroke severity (OR 1.29; CI 1.01 to 1.67; P = 0.042) and predicted worse functional outcome at 12 months (OR 2.68; CI 1.14 to 6.03; P = 0.024). Conclusions. Our study suggests that poor glycemic control (baseline HbA1c) prior to IS is an independent risk factor for poor survival and a marker for increased stroke severity and unfavorable long-term functional outcome.
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