Analysis of risk factors for concurrent stress hyperglycemia in patients with non-diabetic acute cerebral infarction and its effect on cognitive prognosis / 中国综合临床

ABSTRACT

Objective:To explore the related risk factors of stress hyperglycemia in patients with acute cerebral infarction and the effect of stress hyperglycemia on short-term cognitive function and prognosis of acute cerebral infarction.Methods:A prospective study was used to select non-diabetic acute cerebral infarction patients who were hospitalized in Department of Neurology, North China University of Science and Technology Affiliated Hospital from June 2016 to November 2019 for observation.According to the increase in blood sugar, the study subjects were divided into stress hyperglycemia group (107 cases) and normal blood sugar group (202 cases), record two groups of general information.After single-factor and multi-factor analysis, independent risk factors for stress hyperglycemia were screened.The degree of neurologic impairment and cognitive function were evaluated on admission and 30 days after onset of the disease in the two groups.The incidence of complications within 30 days after onset of the disease was recorded, and the outcome evaluation of 30 days after onset was completed.The incidence of adverse prognosis was compared between the two groups.Results:The incidence of stress hyperglycemia was 34.6%.By univariate analysis, the proportion of hypertension history, smoking history and multifocal infarction in stress hyperglycemia group was higher than that in normal blood glucose group (all P<0.05), and age, body mass index (BMI), national institute of health stroke scale(NIHSS) score, admission systolic blood pressure, total cholesterol, low density lipoprotein cholesterol and hypersensitive C-reactive protein (hs-CRP) in the blood glucose group were higher than those in the normal blood glucose group (all P<0.05). Multivariate logistic regression analysis showed that age, admission systolic blood pressure, BMI, NIHSS score and multifocal infarction were independent risk factors of stress hyperglycemia in patients with non-diabetic acute cerebral infarction (all P<0.05); the incidence of cognitive impairment in stress hyperglycemia group was higher than that in normal blood glucose group (21.8% vs.12.7%; χ 2=4.155, P=0.042), and the 30-day MOCA score was lower than that of the normal blood glucose group.According to multivariate Logistic regression analysis, stress hyperglycemia was independently associated with cognitive impairment in the 30 days after acute cerebral infarction( OR=1.788, 95% CI 1.127-2.836, P=0.014). The results showed that the incidence of poor prognosis in stress hyperglycemia group was significantly higher than that in normal blood glucose group ( P<0.05); multivariate logistic regression analysis showed that stress hyperglycemia was independent of other factors related to disease outcome, and closely related to poor prognosis ( OR=1.824, 95% CI1.410-2.664, P=0.003). In addition, disease progression ( OR=2.208, 95% CI1.542-3.104, P<0.001) and severity of admission ( OR=2.340, 95% CI1.670-3.279, P<0.001) were also independent risk factors for poor prognosis. Conclusion:The occurrence of stress hyperglycemia after acute cerebral infarction in non-diabetic patients is the result of multiple factors.It is an independent influencing factor of poor prognosis, and can be used as one of the important reference indicators to predict the disease condition.