Assessment of Capillary Blood Glucose Levels as a Prognostic Indicator in Acute Ischemic Stroke

ABSTRACT

Acute Stroke is an abrupt onset of a neurological deficit attributable to a focal vascular cause. The diagnosis of stroke is based on clinical examination, and brain imaging. Cerebral ischemia is caused by a reduction in blood flow lasting longer than several seconds with manifestation of neurologic symptoms due to infarction or death of brain tissue because neurons utilise only glucose and lack glycogen stores, so energy failure is rapid. Neurologic signs and symptoms lasting for >24 hours or brain infarction demonstrated on brain imaging is known as Acute Stroke.[1] Abnormal blood glucose at the time of acute stroke is associated with poor clinical outcomes, longer in-hospital stay and mortality. We wanted to evaluate the influence of abnormal capillary glucose levels on functional outcomes by grading the Acute Ischemic Stroke patient on modified Rankin scale.METHODSThis cross sectional study was conducted for a period of 6 months in the medicine and neurology wards, ICU in a tertiary care rural hospital in central India and included a total of 35 patients after obtaining institutional ethical committee clearance. The capillary blood glucose samples were taken using a standard glucometer. Capillary blood glucose was determined at the time of admission, each day within the first 72 hrs. Two values of blood glucose were considered; admission value and max. value within the 1st 72 hrs. Functional prognosis was assessed on Modified Rankin scale at the time of discharge or 1 month. The categorical variables were assessed using chi-square test and odd’s ratio and p-value were calculated and assessed. The association of altered capillary glucose levels with functional outcomes on modified Rankin scale were analysed. The data were entered in excel spreadsheet and all the statistical analysis was conducted using STATA version 14.2 software.RESULTSA significant correlation between the higher admission capillary blood glucose levels with the outcomes on modified Rankin scale after 1 month or after discharge was found (p-0.0032). Hyperglycaemia at the time of admission with poor prognosis on mRS (p-value 0.007) was also found.CONCLUSIONSThe results of the study reveal that the patients with admission hyperglycaemia have poor prognosis as compared to the normoglycemic patients. There is a significantly positive correlation between the altered capillary blood glucose levels at the onset of stroke and functional prognosis of the patients with stroke after treatment.