Effect of Admission Hyperglycaemia on Infarct Size and Clinical Outcome in Black Patients with Acute ISCHAEMIC Stroke, Northeast Nigeria

Aims: To determine the relationship between admission blood glucose level, infarct size and stroke outcome in black African patients with acute ischaemic stroke.
Study Design: The study was cross-sectional.
Place and Duration of Study: University of Maiduguri Teaching Hospital, Northeast Nigeria, from January 2006 to January 2009.
Methodology: Sixty-two patients were recruited and clinical characteristics recorded. Stroke severity was assessed using the National Institutes of Health Stroke Score (NIHSS); disability assessed using Modified Rankin score (mRS) and Barthel Activity of Daily Living (ADL) index (BI). Infarct volume was calculated from CT scan using the ‘method of measurements of the largest diameters’. Random blood glucose (RBG) was measured on admission, and dichotomised into those with hyperglycaemia > 7mmol/L those without < 7 mmol/L. Bivariate statistics were used to compare characteristics and outcome. Kaplan-Meier Statistic was used to compare mortality rates. The influence of hyperglycaemia on infarct volume and outcome was determined using logistic regression.
Results: Fourteen (22.6%) patients had hyperglycaemia on admission. Those with hyperglycaemia had a larger infarct volume (P < .0001) and higher NIHSS (P = .003) on presentation. They had worse stroke outcome (Discharge BI: P = .001; NIHSS: P < 0.0001; mRS: P = .001) and higher 30-day mortality (P = .005). Admission RBG positively correlated with infarct size (P < .001), NIHSS (P = .01), mRS (P = .02) and negatively with BI (P = .02). Survival time is significant with Log Rank (P = .009) and Wilcoxon test statistics (P = .006). Hyperglycaemia predicted a larger infarct (OR = 4.46, P = < .0001), poorer NIHSS on discharge (OR = 3.44, P = .001), poorer mRS (OR = 2.53, P = .02) and 30 – day mortality (OR = 2.04, P = .046).
Conclusion: Hyperglycaemia is associated with a larger infarct size, severe stroke at presentation and a worse stroke outcome.