Association between Initial Glycemic Variation and 3-Month Cardiovascular Mortality in Diabetic Patients with Acute Ischemic Stroke

Abstract

Background: Blood glucose fluctuation is linked to mortality in critically or non-critically ill patients, as well as cardiovascular events after acute myocardial infarction. However, its association with poststroke outcome is largely unknown. The aim of this study was to determine whether initial glucose fluctuation is related to cardiovascular mortality in patients with acute ischemic stroke. Methods: We registered consecutive patients with acute ischemic stroke in Soonchunhyang University Hospital between Mar 2005 and Feb 2015. Six hundred and thirty-nine diabetic patients within 72 hours from stroke onset were included. Serum glucose levels were checked 4 times per day during the first 3 hospital days. J-indices were calculated for glycemic variability in all patients, and divided into 4 groups by quartiles. Cardiovascular death and modified Rankin scale at 3 months were prospectively recorded. Multivariable logistic regression analyses were performed after adjusting covariates for outcome variables. Results: Cardiovascular deaths at 3 months were identified in 57 patients (8.9%): 11 (7.1%), 8 (5.1%), 13 (8.0%) and 25 (15.2%) in each of the J-index quartiles, respectively. Multivariable logistic regression analysis indicated that the incidence of cardiovascular deaths were significantly associated with the group of highest J-index (odds ratio 3.38; 95% confidence interval 1.15-12.04; P=.04). Conclusion: Fluctuation of serum glucose during the first 3 days was associated with cardiovascular death at 3 months after acute ischemic stroke. Further studies are required to determine the pathophysiologic correlation between glycemic variation and cardiovascular deaths.

Keywords

• Glucose
• Acute stroke
• Diabetes mellitus
• Hyperglycemia
• Hypoglycemia
• Mortality