Mohammad Sajjad Ali Khan1, Shahzad Ahmad1, Akbar Said Jan2 and Iftikhar Ali Shah1
1Department of Medicine, Department of Anesthesia, Northwest General Hospital, Peshawar, Pakistan
Background: Stroke is the second largest cause of death in adults and more than 20% of diabetic patients are affected. Hyperglycaemia during the period a person suffers from stroke is reported to be associated with poor outcome and survival.
Objective: To analyse the predictive power of glycated haemoglobin (HBA1C) for early functional outcome in terms of modified Rankin Score and early overall survival.
Methods: Prospective observational study conducted at the department of Internal Medicine between July 2015 and December 2016. Diabetic patients who presented with stroke between 45 and 70 years of age were included. All patients were investigated with random blood glucose levels and HBA1C at the time of admission. A receiver operating characteristic (ROC) curve analysis was performed to determine the predictive power of HBA1C on early outcome in terms of modified Rankin Score at discharge and early overall survival.
Results: Of the 146 patients included in this study, there were 48 (32.9%) males and 98 967.1%) females with a mean age of 56.88 ± 4.67 years (range: 47-69).69 (47.3%) cases had their random blood sugar (RBS) of more than 200 mg/dL. The mean HBA1C at the time of admission was 8.17 ± 1.64 %.The mortality rate was 21.2% (n = 31) and mean mRS at the time of discharge was 3.75 ± 1.56.A ROC curve was obtained utilising the HBA1C levels against the outcome categorised as favourable (mRS ≤3 at discharge) or unfavourable (mRS ≥3 at discharge). The ROC curve was significant (p <0.0001) with an area under the curve (AUC) of 95% (95% confidence interval (CI) 0.92 to 0.99). At the cut-off limit of 7.5% of HBA1C, the sensitivity was 91.9% and specificity of 91.7%.
Conclusion: The glycated haemoglobin level is a strong predictor of functional outcome as well as in-hospital mortality. It may be used as a prognostic tool to direct intensive therapies in diabetic stroke patients.