Is diabetes an independent risk factor for in-hospital complications after a stroke?

• Published in: Journal of diabetes Vol. 7; no. 5; pp. 657 - 663
• Main Authors: Cruz-Herranz, Andrés, Fuentes, Blanca, Martínez-Sánchez, Patricia, Ruiz-Ares, Gerardo, Lara-Lara, Manuel, Sanz-Cuesta, Borja, Díez-Tejedor, Exuperio
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.09.2015; John Wiley & Sons, Inc
• Subjects: Age Factors; Aged; Aged, 80 and over; Blood Glucose - metabolism; Brain Ischemia - blood; Brain Ischemia - complications; Brain Ischemia - diagnosis; complications; Diabetes; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Female; Humans; hyperglycemia; ischemic stroke; Male; Middle Aged; Registries; Risk Factors; Severity of Illness Index; Stroke; Stroke - blood; Stroke - complications; Stroke - diagnosis; 关键词：并发症，糖尿病，高血糖，缺血性中风，中风; hyperglycemia; complications; diabetes; stroke; ischemic stroke; 关键词：并发症，糖尿病，高血糖，缺血性中风，中风
• ISSN: 1753-0393; 1753-0407
• DOI: 10.1111/1753-0407.12222

Background Patients with diabetes mellitus (DM) are more likely to develop in‐hospital complications (IHCs) than patients without DM. In addition, they have poorer outcomes after an ischemic stroke (IS). Our goal was to evaluate whether the increase in risk for the development of IHCs in patients with IS is due to DM per se, to poor metabolic control of the DM or to glucose levels on admission. Methods An observational study that included 1137 consecutive IS patients admitted to a stroke unit. Demographic data, vascular risk factors, stroke severity, on‐admission glycemia and IHC were compared between patients with and without DM. Multivariate logistic regression analyses were performed to identify factors associated with IHCs. Results Of all included patients, 283 (24.8%) had a previous diagnosis of DM. These patients were older and had higher comorbidity, with no differences in stroke severity. They presented on‐admission glycemia ≥155 mg/dL more often and suffered IHCs more frequently (24% versus 17.7%, P = 0.034). However, after adjusting for baseline differences, DM was not associated with the development of any IHC, whereas on‐admission glycemia ≥155 mg/dL (odds ratio: 1.959; 95% CI 1.276–3.009; P = 0.002) and stroke severity (odds ratio: 1.141; 95% CI 1.109–1.173; P < 0.001) were the primary predictors of the development of IHCs. Conclusions Although IS patients with DM more often suffered IHCs, previous diagnosis of DM is not per se associated with the risk of IHCs. Stroke severity and on‐admission glycemia ≥155 mg/dL were the most significant predictors for the development of IHCs. 摘要 背景： 与没有糖尿病（DM）的患者相比，DM患者更有可能发生院内并发症（in‐hospital complications，IHCs）。另外，他们发生缺血性卒中（ischemic stroke，IS）后的预后更差。我们的目的是评估IS患者发生IHCs的风险增加是否是因为DM本身，还是因为DM导致的代谢指标控制不佳或是入院时的血糖水平。 方法： 这是一项观察性研究，连续性地纳入了1137名入住卒中病房的IS患者。比较了合并DM患者与不合并DM患者之间的人口数据、血管危险因素、卒中严重程度、入院时的血糖以及IHC。使用多元logistic回归分析来鉴别IHCs相关的危险因素。 结果： 在所有的入组患者中，有283（24.8%）名患者既往被诊断为DM。这些患者年龄更大，并且合并症更多，但是卒中的严重程度没有差异。他们在入院时血糖≥155 mg/dL的比例更高，并且更容易发生IHCs（分别为24%与17.7%，P = 0.034）。然而，校正基线差异后，DM与发生任何IHC都没有相关性，但入院时的血糖≥ 155 mg/dL（优势比：1.959；95% CI：1.276–3.009；P = 0.002）以及卒中严重程度（优势比：1.141；95% CI：1.109–1.173；P < 0.001）却是发生IHCs的主要预测因子。 结论： 虽然合并DM的IS患者更容易出现IHCs，但是既往诊断为DM本身与IHCs风险之间并没有相关性。卒中严重程度以及入院时的血糖 ≥155 mg/dL是发生IHCs最显著的预测因子。