ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 P129 | DOI: 10.1530/endoabs.63.P129

Long term functional prognosis is worse in patients with chronic hyperglycemia

Julia Silva-Fernández1, Rafael García-Ruiz2, Francisco Javier Gómez-Alfonso1, Florentino Del Val-Zaballos1, Belvis Torres-Arroyo1, Paloma González-Lázaro1, Cristina Contreras-Pascual1, Critina Montalbán-Méndez1 & Inés Gómez-García1

1Endocrinology Department, Mancha Centro General Hospital, Alcázar de San Juan, Spain; 2Neurology Department, Mancha Centro General Hospital, Alcázar de San Juan, Spain.

Diabetes and acute hyperglycemia are known to increase stroke volume and disability in stroke patients, and deliver worse outcomes after reperfusion therapies. Chronic glycemic status has recently been linked to stroke functional outcome, but its impact on long term prognosis of stroke has rarely been studied. We conducted a study to investigate the impact of glycosylated hemoglobin (HbA1c) levels on functional outcome 1 year after stroke.

Methods: Patients with acute stroke or TIA were prospectively included. Sociodemographic factors, premorbid conditions, and clinical, biochemical and hematological parameters that were considered as possible prognostic factors in previous studies were collected, as well as modified Rankin Scales (mRS) scores at different times. Multivariate logistic regression analyses were conducted to identify factors related to achieving functional independency 12 months after stroke. HbA1c levels higher than 6.4% were considered as pathologic.

Results: 382 patients were included. In 217 of them (56.81%) mRS was 2 or less 12 months after stroke, while 167 (43.19%) had a mRS ≥ 3. Medium HbA1c on admission was 6.6±1.55% (6.29±1.43% vs 6.76±1.70%; P=0.032). Additionally, 130 patients (34.03%) had HbA1c levels higher than 6.4% (23.08% vs 44.76%; P<0.001). In multivariate analysis for functional independency, elevated HbA1c level was an independent predictor of functional dependency 1 year after stroke (OR 0.190; CI 95% 0.064–0.568; P=0.003).

Conclusions: Chronic glycemic status is an independent prognostic factor for long term outcome after stroke, as patients with higher HbA1c are more frequently disabled one year after the event. We propose that HbA1c levels should be determined in all stroke patients to help physicians predict functional status after stroke.