medigraphic.com

2016, Number 3

<< Back Next >>

Rev Cuba Endoc 2016; 27 (3)

Prognostic value of hyperglycemia in hospitalized patients suffering cerebrovascular diseases

Licea PME, Cala CJC

Language: Spanish
References: 43
Page: 30-44
PDF size: 183.14 Kb.


ABSTRACT

Background: presence of hyperglycemia in a critical patient is a sign of bad prognosis.
Objective: to determine the relationship between hyperglycemia and prognosis in hospitalized patients suffering cerebrobascular diseases with/without type 2 diabetes mellitus.
Methods: Cross-sectional, descriptive and correlational study which analyzed 570 clinical histories of hospitalized patients suffering cerebrovascular disease in the 2010-2012 period in "Comandante Manuel Fajardo" university hospital located in Havana. They were divided into 3 groups: 1) no history of type 2 diabetes mellitus with hyperglycemia seen in the first glycemia test on fasting 2) previous diagnosis of type 2 diabetes mellitus and 3) normoglycecimia without type 2 diabetes. The studied variables were clinical ones, first glycemia on fasting, glycemia average during the hospital stay, anti-hyperglycemia treatment based on insulin therapy (indications and modalities [conventional or multiple doses]), progression of diabetes and its complications; and they were correlated with type of cerebrovascular disease and prognosis.
Results: ischemic disease significantly predominated over the hemorrhagic disease in all the groups 1) 77.2 %, 2) 91.6 % and 3) 91.8 %. It was associated to ages over 70 years (p= 0.002), being female (p= 0.042) and glycemia average values during hospitalization (p= 0.000). The cutoff point of the first glycemia on fasting and the glycemia average values during hospitalization was 7.3 mmol/L for neurological complications, 6.9% for extra-neurological ones and 7 mmol/L for mortality.
Conclusions: first glycemia on fasting and the glycemia average values during hospitalization are bad prognosis indicators in patients with a cerebrovascular disease.


REFERENCES

  1. Zevir J. Patología vascular cerebral isquémica. En: Golman L, Schaffer A, Armitage A, Arozen N, Rustgi L. Cecil Goldman Tratado de Medicina Interna. 24ed Vol. 2. Madrid: Editorial Elsevier Saunder; 2013. p. 2314-24.

  2. Saposnik G, Del Brutto OH. Stroke in South America: a systematic review of incidence, prevalence, and stroke subtypes. Stroke. 2003;34:2103-7.

  3. Cuba. Misap. Anuario Estadístico de Salud-2012. Dirección Nacional de Registros Médicos y Estadísticas de Salud. La Habana; 2013.

  4. Nerving B, Kissela B. The global burden of stroke and need for a continuum of care. Neurology. 2013;80(suppl.2):S5-S12.

  5. American Diabetes Association. Standards of Medical Care in Diabetes 2009. Diabetes Care. 2009;32(suppl 1):S13-S61.

  6. Boden-Albala B, Cammack S, Wang C, Rundek T, Elkind M. Diabetes, fasting glucose levels, and risk of ischemic stroke and vascular events. Finding from the Northern Manhattan Study (NOMAS). Diabetes Care. 2008;31:1132-7.

  7. Lang J, Licea ME, Borges R, Revilla R, Reina A. La diabetes mellitus y su relación con la enfermedad cerebrovascular: estudio de 265 casos. Rev Cubana Endocrinol. 1992;3:122-32.

  8. Méndez M, Dubois C, Sinnaeve P, Piessens J, Desmet W. La hiperglucemia de ingreso se asocia a mayor mortalidad en personas con IAM y supra desnivel del ST sometidos a angioplastia primaria. Rev Chilena Cardiol. 2006;25:253-8.

  9. Sánchez Ch. Accidentes cerebrales vasculares. En: Farrera/Rosman. Medicina Interna. XIIed Vol. 2. Madrid: Editorial Elsevier; 2012. p. 1334-47.

  10. American Diabetes Association. Standards of Medical Care in Diabetes-2013. Classification and diagnosis. Diabetes Care. 2013;36(suppl 1):S11.

  11. Trider P. Determination of glucose in blood using glucose-oxidase with alternative oxygen acceptor. Ann Clin Biochem. 1969;6:24-7.

  12. Romero B, Aguilera JM, Castela A. Enfermedad cerebrovascular. Doyma. 2007;9(72):4581-8.

  13. The Seventh Report of the Joint National Committee on Prevention, Detection and Treatment of High Blood Pressure. Hypertension. 2003;42:1206-25.

  14. Sánchez LJ, Rodríguez RI, Díaz DM. Ataque transitorio de isquemia, el heraldo del ictus. Rev Cubana Plantas Medicinales. 2012;31:108-22.

  15. Blanco M, Rodríguez-Yanes M. Ataque isquémico transitorio y riesgo de trombosis cerebral en pacientes con diabetes: prevención y tratamiento. Av Diabetol. 2010;26:403-7.

  16. Eckel RH, Kahn R, Robertson RM, Rizza RA. Preventing cardiovascular disease and diabetes: a call to action from the American Diabetes Association and the American Heart Association. Circulation. 2006;113:2943-6.

  17. Fernández L, Díaz N, Guevara IM. Estudio de factores de riesgo de la enfermedad cerebrovascular en el Policlínico Docente "Doctor Carlos J. Finlay". Rev Cubana Med Gen Integr [serie en Internet]. 2004 Feb [citado 19 de octubre de 2013];20(1). Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864- 21252004000100005&lng=es&nrm=iso&tlng=es

  18. Kissela BM, Lhoury J, Kleindorfer D, Woo D, Schneider A, Alwell K, et al. Epidemiology of Ischemic Stroke in Patients With Diabetes. The Greater Cincinnati/Northern Kentucky Stroke Study. Diabetes Care. 2005;28:355-9.

  19. Folsom AR, Rasmussen ML, Chambless LE, Howard G, Cooper LS, Schmidt MI, et al; For The Atherosclerosis Risk In Communities (ARIC) Study Investigators. Prospective Associations of Fasting Insulin, Body Fat Distribution and Diabetes with Risk of Ischemic Stroke. Diabetes Care. 1999;22:1077-83.

  20. Rodríguez BL, D'Agostino R, Abbott RD, Kagan A, Burchfiel CM, Yano K, et al. Risk of hospitalized stroke in men enrolled in the Honolulu Heart Program and the Framingham Study: a comparison of incidence and risk factor effects. Stroke. 2002;33:230-6.

  21. Rodríguez JM, Polanco F, Olivera LO, Pérez JL, Fabelo CJ, Rodríguez I. Comportamiento de la enfermedad cerebrovascular en un período de dos años. Rev Cubana Med Milit [serie en Internet]. 2006 Dic [citado 19 de octubre de 2013];35(4). Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0138- 65572006000400003&lng=es&nrm=iso&tlng=es

  22. Blacher J, Evans A, Arveiler D, Amouyel P, Ferrier's J, Bingham A, et al. Residual cardiovascular risk in treated hypertension and hyperlipidemia: the PRIME Study. J Human Hypertens. 2010;24:19-26.

  23. Weng WC, Huang WY, Su FC, Chien YY, Wu CL, Lee TH, et al. Less favorable neurological recovery after acute stroke in patients with hypercholesterolemia. Clin Neurol Neurosurg. 2013:S0303-8467(13):00041-00043.

  24. Morrish NJ, Wang SL, Stevens LK, Fuller JH, Keen H. Mortality and causes of death in the WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia. 2001;44(suppl. 2):S14-21.

  25. Paul SL, Thrift AG, Donnan GA. Smoking as a crucial independent determinant of stroke. Tob Induc Dis. 2004;2:67-80.

  26. Rodero L, González R. Accidente cerebrovascular. Concepto. Clasificación. Valoración sindrómica. Epidemiología. Impacto socioeconómico. Medicine-Programa de formación Médica Continuada Acreditada. 2003;8:4903-10.

  27. Dorjgochoo T, Shu XO, Zhang X, Li H, Yang G, Gao L, et al. Relation of blood pressure components and categories and all-cause, stroke and coronary heart disease mortality in urban Chinese women: A population-based prospective study. J Hypertens. 2009;27:468-75.

  28. Valdés E, Bencosme N. Las complicaciones macrovasculares y su relación con algunas variables clínicas y bioquímicas en diabéticos tipo 2. Rev Cubana Endocrinol. 2010;21:256-68.

  29. Aruza A, Ruiz A. Enfermedad vascular cerebral. Rev Fac Medina UNAM. 2012;55:11-21.

  30. Fernández O, Buergo MA, López M. Hiperglicemia post-ictus. Rev Cubana Neurol Neurocir. 2012;2:144-9.

  31. Poppe AY, Majumdar SR, Jeerakathil T, Ghali W, Buchan AM, Hill MD. On Behalf of the Canadian Alteplase for Stroke Effectiveness Study (CASES) Investigators. Admission Hyperglycaemia Predict a Worse Outcome in Stroke Patients Treated with Intravenous Thrombolysis. Diabetes Care. 2009;32:617-22.

  32. Matz K, Karesztes K, Tatschi C, Nowotny M, Dachenhausen A, Brainin M. Disorders of glucose metabolism in acute stroke patients: An under recognized problem. Diabetes Care. 2006;29:792-7.

  33. Masharan U, German MS. Hormonas pancreáticas y diabetes mellitus. En: Gardner DG, Shoback CK. Greenspan Endocrinología básica y clínica. 9ed Ed. Madrid: McGrew Hill Lange; 2012. p. 574-655.

  34. Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a Guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke. 2007;38:2001-23.

  35. The European Stroke Initiative Writing Committee and the Writing Committee for the EUSI Executive Committee. Recommendations for the management of intracranial hemorrhage. Part I: spontaneous intracerebral hemorrhage. Cerebrovasc Dis. 2006;22:294-316.

  36. Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically patients. N Eng J Med. 2001;345:1359-67.

  37. Pérez A. Objetivos de control glucémico en los pacientes críticos. Reflexiones acerca del estudio NICE-SUGAR. Av Diabetol. 2009;25:347-9.

  38. The NICE-SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283-97.

  39. Adviye E, Weiguo L, Mostafa ME, Askiel B, Fagan SC. Hyperglycemia, diabetes and stroke: Focus on the cerebrovasculature. Vasc Pharmacol. 2009;51:44-9.

  40. Sweileh WM, Sawalha AF, Al-Aqad SM, Zyoud SH, Al-Jabi SW. Predictor of inhospital mortality after acute stroke: impact of gender. Int J Clin Exp Med. 2008;1:41-7.

  41. Félix FJ, Consuegra L, Ramírez JM, Lozano L, Escudero V, Fernández-Bergés D . Ischemic stroke mortality tendency (2000-2009) and prognostic factors. ICTUS Study-Extremadura (Spain). Rev Clin Esp. 2013;213:177-85.

  42. Tejada J, Redondo L. Epidemiología de la enfermedad vascular cerebral en los pacientes con diabetes. Av Diabetol. 2010;26:377-402.

  43. Caballero López A. Enfermedad Cerebrovascular en Tratado de Terapia Intensiva. 2da ed. La Habana: Editorial Ciencias Médicas; 2008. p. 1030-51.




2020     |     www.medigraphic.com