Admission hyperglycemia, in-hospital glycemic management, and discharge outcomes in acute ischemic stroke: a UAE comprehensive stroke center cohort.
Hyperglycemia at presentation is common after acute ischemic stroke and is associated with worse functional outcomes. We examined whether admission hyperglycemia independently predicted unfavorable discharge outcomes, quantified adherence to the SHINE trial-aligned management standards, and tested the stress hyperglycemia ratio (SHR) as an alternative exposure variable.
This single-center retrospective cohort study included 218 consecutive adults with acute ischemic stroke admitted to the Tawam Stroke Center, Al Ain, United Arab Emirates, between July 1 and December 31, 2023. The primary exposure was an admission capillary glucose level >7.8 mmol/L. Two co-primary outcomes were defined a priori: unfavorable discharge modified Rankin Scale (mRS) scores of 3-6 and in-hospital death. Glycemic management adherence was analyzed as a parallel process measure across 13 q6-h time points. Multivariable logistic regression was adjusted for the pre-specified nine-covariate set (age, sex, NIHSS severity, and six clinical comorbidities). Bonferroni correction was applied across the two co-primary outcomes (α = 0.025).
Admission hyperglycemia (51.7%) was associated with unfavorable mRS (adjusted OR 3.43, 95% CI 1.33-8.87, p = 0.011; surviving Bonferroni correction). Mantel-Haenszel pooled OR across NIHSS strata: 3.47 (p<0.001). Inappropriate management occurred in 85.8% of hyperglycemic versus 11.1% of euglycemic patients (adjusted OR 80.59, p < 0.001). Routine HbA1c testing identified occult diabetes in 18.4% of patients without prior diagnosis. No severe hypoglycemia occurred.
Admission hyperglycemia tripled the adjusted odds of unfavorable discharge outcome and identified patients receiving non-adherent management. Structured admission orders, q6h monitoring and routine HbA1c testing are immediate, low-cost quality improvement targets for Gulf stroke services.
This single-center retrospective cohort study included 218 consecutive adults with acute ischemic stroke admitted to the Tawam Stroke Center, Al Ain, United Arab Emirates, between July 1 and December 31, 2023. The primary exposure was an admission capillary glucose level >7.8 mmol/L. Two co-primary outcomes were defined a priori: unfavorable discharge modified Rankin Scale (mRS) scores of 3-6 and in-hospital death. Glycemic management adherence was analyzed as a parallel process measure across 13 q6-h time points. Multivariable logistic regression was adjusted for the pre-specified nine-covariate set (age, sex, NIHSS severity, and six clinical comorbidities). Bonferroni correction was applied across the two co-primary outcomes (α = 0.025).
Admission hyperglycemia (51.7%) was associated with unfavorable mRS (adjusted OR 3.43, 95% CI 1.33-8.87, p = 0.011; surviving Bonferroni correction). Mantel-Haenszel pooled OR across NIHSS strata: 3.47 (p<0.001). Inappropriate management occurred in 85.8% of hyperglycemic versus 11.1% of euglycemic patients (adjusted OR 80.59, p < 0.001). Routine HbA1c testing identified occult diabetes in 18.4% of patients without prior diagnosis. No severe hypoglycemia occurred.
Admission hyperglycemia tripled the adjusted odds of unfavorable discharge outcome and identified patients receiving non-adherent management. Structured admission orders, q6h monitoring and routine HbA1c testing are immediate, low-cost quality improvement targets for Gulf stroke services.