The prognostic roles of initial glucose level and functional outcomes in patients with ischemic stroke: difference between diabetic and nondiabetic patients

Abstract

Purpose: To identify the prognostic roles of initial glucose level in the emergency department among patients with acute ischemic stroke, and to evaluate whether or not the impact varied with diabetes. Methods: A total of 774 first-ever ischemic stroke patients admitted to the emergency department of a tertiary hospital in Taiwan. Participants were stratified into tertiles by initial glucose level in the emergency department. The Barthel Index (BI) and modified Rankin Scale (mRS) were used to assess functional outcome 3 months after the ischemic stroke. Results: Initial glucose level was significantly associated with functional outcome 3 months after ischemic stroke. Compared with the 1st tertile, adjusted odds ratios for 2nd and 3rd tertiles of initial glucose level were 1.84 (95% confidence interval [CI], 1.15–2.95) and 4.57 (95% CI, 2.87–7.29), for BI of less than 60, 2.07 (95% CI, 1.28–3.36) and 4.45 (95% CI, 2.76–7.18) for mRS score of >2. The association was apparent among the nondiabetic stroke patients compared with diabetic patients. Conclusions: A positive association was found between initial glucose level and poor functional outcome at 3 months in patients with acute ischemic stroke, particularly among nondiabetic patients.

Implications for Rehabilitation

• Hyperglycemia is an independent risk factor for poor functional outcome among patients with acute ischemic stroke.

• The prognostic role of post-stroke hyperglycemia is altered by the presence of diabetes mellitus.

• Those patients with higher initial glucose level tend to receive higher intensity of rehabilitation after ischemic stroke.

Keywords::

• blood glucose
• diabetes mellitus
• functional outcome
• stroke

Acknowledgements

The authors express their thanks to the participants in the study.

Declaration of interests: All authors have no conflicts of interests.