Glycaemic levels as an independent predictor of outcome in acute ischemic stroke from a tertiary care hospital, Nellore, India


  • Usham Gangraram Department of General Medicine, Narayana Medical College, Nellore, Andhra Pradesh, India
  • Malli Dorasanamma Department of General Medicine, Narayana Medical College, Nellore, Andhra Pradesh, India
  • Ishwarya Thiruvuru Department of General Medicine, Narayana Medical College, Nellore, Andhra Pradesh, India
  • K. Sivarama Krishna Department of General Medicine, Narayana Medical College, Nellore, Andhra Pradesh, India



Acute ischemic stroke, Diabetes mellitus, Hyperglycaemia


Background: Stroke is one of the most important causes of long-term disability and the second leading cause of death worldwide. Increasing interest has been focused on the role of hyperglycaemia in the evolution of acute ischaemic stroke because of its risk on stroke outcome and also hyperglycaemia occurs in 30-40% of patients with acute ischaemic stroke; most of these individuals do not have a history of diabetes mellitus.

Methods: This study subjects consisted of 100 consecutive patients who presented to the Narayana Medical College and Hospital, Nellore with acute ischaemic stroke within 24 hrs of symptom onset and had capillary blood glucose (CBG) measured on presentation. Patients with hyperglycaemia (CBG>140 mg/dl) were then stratified into those with stress hyperglycaemia, newly detected diabetes mellitus and with pre-existing diabetes mellitus for the purpose of analysis. The outcome of stroke in terms of functional impairment and 90-day mortality were studied.

Results: Patients with hyperglycaemia exhibited significantly greater functional impairment (p<0.0001) than those with normoglycemia. The outcome was poor in patients with hyperglycaemia. Stroke severity (p<0.001) and functional impairment (p<0.001) were both significantly worse in patients with Hyperglycaemia and no prior history of DM; when compared to a patient with hyperglycaemia and previously diagnosed DM.

Conclusions: This study concludes that hyperglycaemia at stroke onset is associated with a higher risk of poor outcome independent of the other variables. Patients with hyperglycaemia at stroke onset, without prior history of DM, have a particularly poor prognosis, then that of patients with known diabetes. Thus, hyperglycaemia is not solely a stress response to neurological insult, as it predicts outcome. Hence, hyperglycaemia needs to be treated to have reduced morbidity and mortality pertaining to stroke outcome.


Vereshchagin NV, Sartorius N, Orgogozo JM, Goldstein M, Barnett HJ, Symon L. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke. J Cerebral Circulation. 1989;20:1407-31.

Baird TA, Parsons MW, Phan T, Butcher KS, Desmond PM, Tress BM, et al. Persistent poststroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome. Stroke. 2003;34(9):2208-14.

Luitse MJ, Biessels GJ, Rutten GE, Kappelle LJ. Diabetes, hyperglycaemia, and acute ischaemic stroke. Lancet Neurol. 2012;11(3):261-71.

Beul DS. Stroke in the diabetic patient. Diabetes Care. 1994;17(3):213-9.

Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed Diabetes. J Clin Endocrinol Metabolism. 2002;87(3):978-82.

Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke. 2001;32(10):2426-32.

Kruyt ND, Biessels GJ, DeVries JH, Roos YB. Hyperglycemia in acute ischemic stroke: pathophysiology and clinical management. Nature Reviews Neurol. 2010;6(3):145.

Stead LG, Gilmore RM, Bellolio MF, Mishra S, Bhagra A, Vaidyanathan L, et al. Hyperglycemia as an independent predictor of worse outcome in non-diabetic patients presenting with acute ischemic stroke. Neurocritical Care. 2009;10(2):181-6.

Kostulas N, Markaki I, Cansu H, Masterman T, Kostulas V. Hyperglycaemia in acute ischaemic stroke is associated with an increased 5-year mortality. Age Ageing. 2009;38(5):590-4.

Kissela BM, Khoury J, Kleindorfer D, Woo D, Schneider A, Alwell K, et al. Epidemiology of ischemic stroke in patients with Diabetes: the greater Cincinnati/Northern Kentucky Stroke Study. Diabetes Care. 2005;28(2):355-9.

Megherbi SE, Milan C, Minier D, Couvreur G, Osseby GV, Tilling K, et al. Association between diabetes and stroke subtype on survival and functional outcome 3 months after stroke: data from the European BIOMED Stroke Project. Stroke. 2003;34(3):688-94.

Hossain AM, Ahmed NU, Rahman M, Islam MR, Sadhya G, Fatema K. Analysis of sociodemographic and clinical factors associated with hospitalized stroke patients of Bangladesh. Faridpur Medical College J. 2011;6(1):19-23.

Lindsberg PJ, Roine RO. Hyperglycemia in acute stroke. Stroke. 2004;35(2):363-4.

Melamed E. Reactive hyperglycaemia in patients with acute stroke. J Neurol Sci. 1976;29(2-4):267-75.

Toni D, Sacchetti ML, Argentino C, Gentile M, Cavalletti C, Frontoni M, et al. Does Hyperglycaemia play a role on the outcome of acute ischaemic stroke patients? J Neurol. 1992;239(7):382-6.






Original Research Articles