Main Organiser

Julius Centre University of Malaya

Co-organiser

Department of Social and Preventive Medicine, Faculty of Medicine, University of Malay

Supported by

University of Malaya

RELATIONSHIP OF INITIAL GLUCOSE LEVEL AND ALL CAUSE DEATH IN PATIENTS WITH ISCHEMIC STROKE: THE ROLES OF DIABETES MELLITUS AND GLYCATED HEMOGLOBIN LEVEL

Author

Gwo-Chi Hu 1 , Shiau-Fu Hsieh 1 , Hui-Kung Yu 2 , Yi- Min Chen 3 , Kuo-Liong Chien 4

Institution

1 Department of Rehabilitation Medicine, Mackay Memorial Hospital, Taipei, Taiwan
2 School of Nursing, Mackay Medicine, Nursing and Management College, Taiwan
3 Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan
4 Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan

Abstract

Objectives: Previous studies demonstrated that post-stroke hyperglycemia were associated with poor outcome in non-diabetic patients. However, evidence was inconclusive among diabetic patients. The aim of this study was to evaluate the relationship between initial glucose levels and mortality among patients with acute ischemic stroke, and further, to assess whether the association varied by diabetes mellitus and glycated hemoglobin (HbA1c) levels.

Methods: Data were collected from the medical records of 1277 first-ever stroke patients admitted to the emergency room between January 1st 2008 and June 30th 2009. Cox regression analysis was performed to assess the relationship between initial glucose level and mortality.

Results: A higher initial glucose level was associated with increased risk for mortality after adjusting for confounding factors (P for trend < 0.001 for all-cause death; P for trend = 0.05 for cardiovascular death). In non-diabetic subgroup, those patients within the highest quartile of initial glucose level had a 3.16-fold relative risks (RR) (95% confidence interval [CI], 1.57-6.37) for all- cause and a 2.79-fold RR (95% CI, 1.05-7.46) for cardiovascular death compared with those within the lowest quartile level. However, the association between initial glucose levels and the risk of death was not significant among patients with diabetes (P for interaction=0.01). In addition, the risk among diabetic patients varied by the HbA1c levels

Conclusion: A significant association was confirmed between initial glucose level and mortality in non-diabetic ischemic stroke patients. The possible relationship between initial glucose level, HbA1c level and mortality among diabetic ischemic stroke patients warrants further research.