Glycated Hemoglobin Level is Associated with Neurological and Functional Outcome in Acute Ischemic Stroke

Introduction: Among all the neurologic diseases of adult life, stroke ranks first in frequency and importance. Stroke is one of the leading causes of mortality and morbidity worldwide. Approximately 20 million people each year will suffer from stroke and of these 5 million will not survive. Materials and Methods: An observational study of 90 acute ischemic stroke (AIS) patients, presenting within 24 h of onset, was under taken. Patients were divided into three groups, non-diabetic (glycated hemoglobin [HbA1c] <5.7%), pre-diabetic (HbA1c 5.7-6.4%), and diabetic (HbA1c >= 6.5%) on the basis of HbA1c levels. Neurological status was assessed by NIHSS (National Institutes of Health Stroke Scale) score on admission and on day 7/discharge which ever was earlier. Post-stroke functional impairment was assessed by Modified Rankin Scale (MRS) on day 7/discharge whichever was earlier. Neurological outcomes were neurological improvement defined as four-point decrease in NIHSS during hospitalization or a 0 point status on NIHSS on day 7 or at discharge and neurological deterioration defined as = 1 point increase in NIHSS during hospitalization. A poor functional outcome was defined as death (MRS 6) or dependency (MRS 2-5). Results: The average age of the patients was 55.88 +/- 11.67 years. The average HbA1c level of AIS patients on admission was 6.61% +/- 2.06%. Neurological improvement was noted in non-diabetic group as there was decrease in mean NIHSS score from admission to day 7. Neurological deterioration was noted in pre-diabetic and diabetic groups as there was increase in mean NIHSS score from admission to day 7. Poor functional outcomes as defined by higher MRS score on discharge, were noted in prediabetic and diabetic patients. Conclusion: HbA1c level is an important tool to know the prognosis in AIS. Both diabetes and pre-diabetes are associated with poor neurological and functional outcome as compare to non-diabetes in AIS.