Correlation Between Acute Hyperglycemia And The Severity And Prognosis In Thrombolytic Patients With Ischemic Stroke

Objective:To explore the correlation between random blood glucose at admission and the severity of disease before thrombolysis and prognosis after 90 days in acute ischemic stroke patients;to investigate the correlation between fasting blood glucose on the next day after admission and the severity of disease after thrombolysis and the prognosis after 90 days in patients with thrombolysis after acute ischemic stroke;to explore the factors affecting the poor prognosis at 90 days after thrombolysis in patients with acute ischemic stroke.Methods:Patients admitted to the Department of Neurology,Zhongda Hospital affiliated to Southeast University,from December 2016 to December 2017 and underwent alteplase thrombolytic therapy was consecutively and retrospectively enrolled.The disease severity was evaluated by the National Institutes of Health Stroke Scale(NIHSS)score and routine blood,biochemical,fibrinolytic function,and brain CT scans were completed before thrombolysis.According to whether the random blood glucose at admission was?7.8 mmol/L,patients were divided into hyperglycemia group and normoglycemic group.The NIHSS score before thrombolysis and the modified Rankin scale(mRS)after 90 days of disease were compared between the two groups;according to whether the fasting blood glucose level on the next day of admission was>6.1 mmol/L,the patients were divided into hyperglycemia group and normoglycemic group(there was 0 cases of patient in the hypoglycemia group).The NIHSS scores after thrombolysis and modified Rankin scale(mRS)scores after 90 days of disease were compared between the two groups.According to the mRS score after 90 days of disease,the patients were divided into favorable prognosis group and poor prognosis group.The vascular risk factors,clinical data,laboratory tests,and imaging results were analyzed.The univariate analysis of variance and multivariate logistic regression were used to explore the factors affecting the poor prognosis after 90 days.The difference was statistically significant at P<0.05.Results:A total of 120 patients received thrombolytic therapy,symptomatic intracranial hemorrhage occurred in 5 cases,including 2 cases of death;6 cases were lost to follow-up during the 90-day follow-up,and a total of 114 cases were eventually included.As for the random blood glucose at admission,there were 46cases of patients in the hyperglycemia group and 74 cases in the normoglycemic group.The NIHSS scores in the hyperglycemic group(13.40±6.572)were significantly higher than that in the normoglycemic group(9.64±4.830)(t=-1.910,P<0.05),and the difference was statistically significant.Meanwhile,it was found that the hyperglycemia group was positively correlated with neurological deficits(r=0.41,P<0.05);There were 54 cases of patients with poor prognosis after 90 days of follow up,accounting for 47.4%of the total.And the 90-day mRS score in the hyperglycemia group was not significantly higher than that of the normoglycemic group(?~2=0.241,P>0.05),the difference was not statistically significant.As for the fasting blood glucose,there were 39 cases(32.5%)in hyperglycemic group and 81cases(67.5%)in normoglycemic group,and 0 cases in hypoglycemia group.The NIHSS score after thrombolysis in the hyperglycemia group was not significantly higher than that in the normoglycemic group,the difference was not statistically significant(t=-1.489,P>0.05).The 90-day mRS score in the fasting glucose hyperglycemic group was significantly higher than that in the normoglycemic group and the difference was statistically significant(?~2=24.305,P<0.05).Logistic regression analysis showed that age(OR:1.053;95%CI:1.015~1.092),diabetes mellitus(OR:1.052;95%CI:1.879~2.179)and NIHSS scores after admission of thrombolysis(OR:1.251;95%CI:1.141~1.371)were independent risk factors for90-day poor prognosis in patients with acute ischemic disease(P<0.05).Conclusion:1.Random blood glucose levels at admission were related to the severity of disease before thrombolysis in acute ischemic stroke,and were not significant correlated with 90-day poor prognosis.2.The level of fasting blood glucose on the following day after admission was not related to the severity of disease after thrombolysis in acute ischemic stroke,and it was significantly related to the 90-day poor prognosis.3.The age,diabetes history,fasting glucose,and the NIHSS score after admission of thrombolysis were independent risk factors for the 90-day prognosis.