Admission Glycaemic Status and Its Correlation with Severity of Acute Cerebral Infarction, Using NIHS Scale in a Tertiary Care Centre, Thodupuzha, Kerala


Rajini Jayakanthan Victor1

80 % of strokes are due to infarction and uncertainty whether stress
hyperglycaemia or chronic dysglycaemia confers poorer outcomes offers a
chance for further research to improve clinical practice. Diabetes mellitus, a
known independent risk factor is associated with 6-fold risk of stroke, with worse
outcome, high morbidity, recurrence, and decreased survival after stroke, with
20 % dying from stroke.
The correlation between admission glycaemic status to clinical severity and
infarct size was investigated in 60 newly diagnosed computed tomography (CT) -
proven cases of acute cerebral infarction. Based on their admission blood
glucose, HbA1C, and diabetes history, the patients were categorized into 3
groups: euglycaemia, stress hyperglycaemia, and diabetic. Based on CT, the
infarcts were classified into three sizes: small, medium, and big. The National
Institute of Health Stroke Scale (NIHSS) scale was used to measure neurological
function on admission and day 10 of the illness.
The average age was 53.9 + 12.9 years, with a male to female ratio of 1.73 : 1.
The 50-60-year age group had the most cases (58.3 %). The prevalence of
hyperglycaemia was 75 %, with admission blood glucose levels ranging from 100
to 512 mg/dL. There were 43.33 % of patients with diabetes, 31.67 % with
stress hyperglycaemia, and 25 % with euglycemia. Severe presentation and high
NIHSS scores were associated with higher admission glucose levels. High NIHSS
score was seen in diabetes with small and medium sized infarcts, and stress
hyperglycaemia with large infarcts (p < 0.05). Stress hyperglycaemic patients
had poor recovery, irrespective of the infarct size (p < 0.001)
High blood glucose levels at admission correlated with infarct size and clinical
severity. NIHSS scores assessed over time in stress hyperglycaemia are linked to
increased severity and poor recovery. Admission glucose and HbA1C both
correlated well with infarct size in diabetes.