TITLE:
Prognostic Signification of Admission Hyperglycemia among Acute Stroke Patients in Intensive Care Units in Kinshasa, the Democratic Republic of the Congo
AUTHORS:
Josée K. Tshituta, François B. Lepira, François P. Kajingulu, Jean Robert R. Makulo, Ernest K. Sumaili, Pierre Z. Akilimali, Aliocha N. Nkodila, Freddy M. Mbuyi, Angèle I. Masewu, Stéphane Mutombo, Eric B. Amisi, Jean Pierre M. Ilunga, Wilfrid B. Mbombo, Patrick M. Mukuna, Adolphe M. Kilembe
KEYWORDS:
Admission Hyperglycemia, Stroke, Prognostic Significance, Black Africans
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.9 No.9,
September
10,
2019
ABSTRACT:
BACKGROUND AND AIM: Although admission hyperglycemia has been reported to
be associated with unfavorable outcomes in acute stroke, little is known about this association
in sub-Saharan Africa. Therefore, the aim of the present study was to assess
the prognostic significance of admission hyperglycemia in the acute phase of
stroke in Congolese patients. METHODS: In a multicenter prospective cohort study, consecutive patients
with acute stroke were examined in 5 Emergency Rooms or
Intensive Care Units of Kinshasa between July 15th, 2017 and March 15th,
2018. The severity of stroke was assessed at admission using the Glasgow Coma
Scale. Stress hyperglycemia was defined as random blood glucose levels at admission > 140 mg/dL in patients without
known type 2 diabetes mellitus (T2DM). The endpoint was 10-day all-cause in-hospital mortality. Survival
(time-to-death) curves were built using the Kaplan Meier methods. Cox
proportional analysis was used to identify predictors of 10-day all-cause in-hospital
mortality. The predictive performance of blood glucose level to predict 10-day all-cause
in-hospital mortality was assessed using ROC curve analysis. RESULTS: Out of 194
patients (mean age 58.7 ± 13.1 years; 64% males, 74.7% light to moderate stroke severity; 63.4%
ischemic stroke) enrolled, 106 (54.6%) had admission hyperglycemia with 77
(72.6%) having stress hyperglycemia. Ninety four deaths (48.5%); mortality rate of 6
deaths per 100 person-days (95%CI 2.7 - 9.3) occurred during a
median follow up time 6 (5 - 7) days equivalent to 1542 person-days. Independent
predictors of 10-day all-cause in-hospital mortality were admission
hyperglycemia regardless of diabetes status (aHR 3.77; 95%CI 1.92 - 7.42; p - 5.23; p = 0.001) and
non-use of mechanical ventilation (aHR 1.97; 95%CI 1.05 - 3.70; p = 0.034).
Blood glucose concentrations (AUC 0.743; 95%CI 0.672 - 0.814) had a better predictive performance
for 10-day all-cause in-hospital mortality with an optimal value of 154 mg/dL
(sensitivity 76.6% and specificity 70%). CONCLUSION: More than
half of critically ill stroke patients exhibit admission hyperglycemia that
impacts negatively on their survival in the acute phase
highlighting thus the need for a better blood glucose control to improve
outcomes.