Akut iskemik inmeli hastalarda kan şekeri yönetiminin hasta sonlanımına etkisi
The effect of blood glucose management on patient outcomes in acute ischemic stroke patients
- Tez No: 832677
- Danışmanlar: DOÇ. DR. NEŞE ÇOLAK
- Tez Türü: Tıpta Uzmanlık
- Konular: Acil Tıp, Emergency Medicine
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2023
- Dil: Türkçe
- Üniversite: Dokuz Eylül Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Acil Tıp Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 61
Özet
AMAÇ: Bu çalışmada kliniğimize başvuran akut iskemik inme hastalarında kan şekeri yönetiminin ve diğer hasta faktörlerinin hasta sonlanımına etkisini incelemeyi amaçladık. YÖNTEM: Bu tanımlayıcı, kesitsel, retrospektif, çalışmaya 01.05.2021 – 01.05.2022 tarihleri arasında Dokuz Eylül Üniversitesi Tıp Fakültesi acil servisine başvuran ve akut iskemik inme tanısı alan ardışık tüm hastalar dâhil edildi. Hastane bilgi yönetim sisteminden hastaların demografik verileri ve komorbid hastalıkları, başvuru ve 24. saatte bakılan kan glikoz düzeyleri ve diğer laboratuvar tetkikleri, komplikasyonları, 7 ve 28. gün sonlanımları kaydedildi. Hastalar başvuru kan glikoz düzeylerine göre hiperglisemik grup (KŞ>140 mg/dL) ve normoglisemik grup olarak, 24. saat kan glikoz düzeylerine göre de hedef düzeylere ulaşanlar (KŞ 60-180 mg/dL arasında olanlar) ve hedef dışında kalanlar olarak gruplandırılarak karşılaştırmaları yapıldı. Verilerin analizinde SPSS 29.0 (IBM Corporation, Armonk, New York, United States) programı kullanıldı. P değeri
Özet (Çeviri)
PURPOSE: In this study, we investigated the effects of glycemic management and other patient factors on the outcomes of patients with acute ischemic stroke who presented to our clinic. METHODS: This descriptive, retrospective, cross-sectional study included all consecutive patients diagnosed with acute ischemic stroke who presented to the emergency department of Dokuz Eylul University Faculty of Medicine between May 1, 2021, and May 1, 2022. Demographic data, concomitant diseases, blood glucose levels on admission and after 24 hours, and other laboratory tests, complications, and outcomes at 7 and 28 days were recorded in the hospital information system. Patients were divided into a hyperglycemic group (FBG > 140 mg/dL) and a normoglycemic group based on blood glucose levels on admission, and into those who reached target levels (FBG between 60-180 mg/dL) and those who did not base on blood glucose levels after 24 hours. SPSS 29.0 (IBM Corporation, Armonk, New York, United States) was used for data analysis. A p-value < 0.05 was considered statistically significant. RESULTS: A total of 308 patients with acute ischemic stroke were included in the study. The median age was 72 years (IQR: 62-81), and 156 (50.6%) of them were male. 48.4% of patients had hyperglycemia on admission. The rate of hyperglycemia on admission and median glucose levels were higher in patients with diagnosed diabetes mellitus (DM) than in non-diabetic patients (74% and median glucose: 186 mg/dL, IQR: 135-276 vs. 30.4% and median glucose: 123 mg/dL, IQR: 103-147; p < 0.001). There were no significant differences between hyperglycemic and normoglycemic patients on admission in terms of age, sex, stroke subtype, and length of hospital stay. Blood sugar results were obtained for 101 out of the 149 patients who had hyperglycemia, and it was determined that 66.3% (n=67) of these patients reached the target blood glucose level. The median age of the group that reached the target value (74 years, IQR: 66-82) was higher than that of the group that did not reach the target value (69 years, IQR: 56-77; p=0.016). There were no significant differences between groups in age, sex, stroke subtype, DM, and comorbidities other than hyperlipidemia. Among patients with DM, 67.4% were still hyperglycemic at 24 hours with a median glucose level of 162 mg/dL (IQR: 131-213), whereas the median glucose level in the nondiabetic patients was 103 mg/dL (IQR: 89-130; p < 0.001). The group that did not reach the target had significantly higher admission glucose levels (236 mg/dL vs. 178 mg/dL) and HbA1c levels (9.4% vs. 7%) compared to the group that reached the target (p < 0.001 for both). In the group of patients who did not reach the target, infections, respiratory system issues, difficulty in swallowing, and other complications were observed more frequently (respectively, p=0.006, p=0.007, p=0.015, p=0.003). Failure to reach the target blood glucose level increases 28-day mortality by 3.3 times, while the development of complications increases it by 7.9 times (respectively, p=0.022 and p=0.002). According to univariate regression analysis, the development of complications increases 7-day mortality by 6.2 times and 28-day mortality by 9.6 times. However, in the multivariate regression analysis, the development of complications increases 28-day mortality by 7.9 times. CONCLUSION: According to the results of our study, the rate of detecting hyperglycemia upon admission is 49% in patients diagnosed with acute ischemic stroke in the emergency department, and 63% of these patients had a diagnosis of diabetes mellitus (DM). Patients with a diagnosis of DM had a higher rate of hyperglycemia upon admission and during follow-up. The rate of having both DM and hypertension (HT) diagnoses was higher among patients with hyperglycemia upon admission, along with higher HbA1c and triglyceride levels and lower HDL levels. Among these patients, those who couldn't achieve the target blood glucose value within 24 hours had a higher mortality and complication rate. Patients who developed complications received more oral antidiabetic, insulin, antihypertensive, anticoagulant, and intravenous crystalloid fluid treatments, and they were more frequently hospitalized. KEY WORDS: stroke, serum glucose level, blood sugar regulation, mortality
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