Association of Poor Long-Term Glycemic Control with Stroke Pattern, National Institutes of Health Stroke Scale Score, and Early Prognosis in Patients with Acute Cerebrovascular Event
Keywords:
Acute stroke; HbA1c; Glycaemic control; NIHSS; Ischemic stroke; Prognosis; Cerebrovascular disease.Abstract
Background: Stroke remains one of the leading causes of mortality and long-term disability worldwide. Diabetes mellitus is a major
modifiable risk factor for cerebrovascular disease, and chronic hyperglycaemia contributes to endothelial dysfunction, accelerated
atherosclerosis, and impaired cerebral circulation. Glycated haemoglobin (HbA1c) reflects long-term glycaemic control over the
preceding two to three months and has emerged as an important biomarker for predicting vascular complications. Although several
studies have evaluated the association between HbA1c and stroke outcomes, evidence regarding its relationship with stroke pattern,
National Institutes of Health Stroke Scale (NIHSS) score, and early prognosis in the Indian population remains limited.
Methodology: A hospital-based cross-sectional observational study was conducted in the Department of Medicine, Pt. JNM Medical
College and Dr. B.R.A.M. Hospital, Raipur, Chhattisgarh, over one year. One hundred consecutive adult patients presenting with
acute cerebrovascular events confirmed by computed tomography (CT) or magnetic resonance imaging (MRI) were enrolled. Clinical
characteristics, vascular risk factors, HbA1c, stroke subtype, NIHSS score at admission, and early clinical outcome were recorded.
Patients were categorized into good glycaemic control (HbA1c <7.0%) and poor glycaemic control (HbA1c ≥7.0%). Statistical
analysis included Chi-square test, independent Student’s t-test, Pearson correlation, and multivariable logistic regression. A p-value
<0.05 was considered statistically significant.
Results: Among the 100 enrolled patients, 62% had poor long-term glycaemic control (HbA1c ≥7.0%). Poor glycaemic control was
significantly associated with ischemic stroke (77.4% vs. 57.9%; p=0.039), higher NIHSS scores (13.8±5.2 vs. 9.7±4.6; p<0.001),
severe stroke (43.5% vs. 18.4%; p=0.012), and poor early clinical outcome (54.8% vs. 26.3%; p=0.006). HbA1c showed a moderate
positive correlation with NIHSS score (r=0.49, p<0.001). Multivariable logistic regression identified HbA1c ≥7.0% (OR 3.46, 95% CI
1.38–8.66; p=0.008), hypertension (OR 2.81, 95% CI 1.10–7.19; p=0.031), and age ≥60 years (OR 2.47, 95% CI 1.01–6.04; p=0.047)
as independent predictors of poor early prognosis.
Conclusion: Poor long-term glycaemic control is significantly associated with greater stroke severity, higher NIHSS scores, ischemic
stroke predominance, and poorer early prognosis in patients with acute cerebrovascular events. HbA1c may serve as a useful prognostic
biomarker for early risk stratification in acute stroke.
Recommendation: Routine HbA1c assessment should be incorporated into the initial evaluation of patients presenting with acute
stroke. Early identification of poor glycaemic control may facilitate risk stratification, optimize management, and improve neurological
outcomes. Larger multicentre prospective studies are recommended to validate these findings.
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