The Influence Of Stress Hyperglycemia On The Activity Of Daily Living In Stroke Patients

Background Stress hyperglycemia represents a transient elevation of the blood glucose in stress condition. This phenomenon occurs due to severe trauma or the stress of illness, such as septic shock, cerebral vascular accident, acute myocardial infarction. It is usually a spontaneous protective response under specific conditons. Different degrees of stress hyperglycemia will affect the development and prognosis of diseases differently. The correlation between stress hyperglycemia and clinical prognosis of cerebral infarction patients as well as the importance of blood glucose controlling is a research focus now.Objective The aim of the study is to analysis literature data on prognostic implications of stress hyperglycemia in patients with cerebral infarction and to investigate the relationship between blood glucose level and relevant clinical parameters in cerebral infarction. Provide a theoretical basis for blood glucose monitoring in cerebral infarction patients.Methods Our retrospective study selected459cases from701cerebral infarction inpatients in Qilu hospital in2010, without diagnosed diabetes or other exclusions. Remove7cases without blood glucose data. The remaining452patients were divided to non-stress hyperglycemia group (Fasting blood glucose≤6.1mmol/L) and stress hyperglycemia group (Fasting blood glucose>6.1mmol/L) which included mild stress hyperglycemia group (6.1mmol/L<Fasting blood glucose<7.0mmol/L) and severe stress hyperglycemia group (Fasting blood glucose>7.0mmol/L). Relevant clinical parameters including sex, age, diseases history, blood biochemistry test, coagulability and hemostatic function test, CT, MRI, ADL Scale (Barthel index) were investigated. Statistical analysis was performed with the statistical package PASW 18.0. Significance is defined as a two tailed P<0.05.Results1. In452cases of non-diabetic cerebral infarction patients there are340cases (75.22%) in non-stress hyperglycemia group and112patients in stress hyperglycemia group (24.78%). Among cerebral infarction patients with stress hyperglycemia there are49cases in mild stress hyperglycemia group and63cases in severe stress hyperglycemia group.2. In non-stress hyperglycemia cerebral infarction group there are66.2%cases with hypertension,25.6%with coronary heart disease,7.4%with history of atrial fibrillation,29.7%with hyperlipidemia and28.5%with recurrent cerebral infarction. While in stress hyperglycemia group there are82.1%cases with hypertension,32.1%with coronary heart disease,21.4%with history of atrial fibrillation,49.1%with hyperlipidemia and33.9%with recurrent cerebral infarction patients. Patients with hypertension, coronary heart disease, atrial fibrillation, hyperlipidemia or recurrent cerebral infarction in stress hyperglycemia group are more than in non-stress hyperglycemia group.(P=0.01,0.18,0.00,0.00,0.28)3. The stress hyperglycemia occurs most often in patients older than65years old, with the history of atrial fibrillation, hypertension or hypertriglyceridemia (triglyceride level isgreater than1.7mmol/L).4. Patients with hemispheric stroke is associated with higher risk of stress hyperglycemia according to452MRI (6cases of CT) reports.5. Fasting blood glucose, BUN, Fib, D-Di are negatively related with stroke patients’ ADL score while PT%is positively related with ADL score.6. There are more patients of lower ADL score ranks in mild stress hyperglycemia group and severe stress hyperglycemia group as compared with non-stress hyperglycemia group. Stress hyperglycemia in cerebral infarction patients increase the risk of long-term activity disorder (rs=-0.2643, P<0.0001)Conclusions Cerebral infarction patients more than65years old, with history of atrial fibrillation, hypertension or hyperlipidemia were at increased risk of stress hyperglycemia. Fasting blood glucose, PT%, Fib and BUN level are associated with the prognosis of cerebral infarction patients. Stress hyperglycemia is related to the damage of daily living activity in patients with Cerebral infarction, indicating that early detecting and better control of stress hyperglycemia may have beneficial effect on the outcome of cerebral infarction.