Nilai Prognostik Kadar Gula Darah Kapiler dan Tekanan Darah terhadap Outcome Stroke Iskemik Akut

Abstract

Introduction : This study aimed to investigate the prognostic value of capillary blood glucose level and blood pressure on acute ischemic stroke outcome. Recently, evidence has been accumulating about the influence of hyperglycemia and blood pressure in acute stroke dan it is becoming an important aspect in stroke management. High glucose levels on admission have been related to poor outcome. Hypertension has also been observed in approximately 80% patients with acute stroke. Although this is considered as a compensation mechanism to maintain cerebral perfusion, but the increase of blood pressure was also associated with poor outcome and the increase of stroke reccurency. Although a linear relationship between hyperglycemia, hypertension and stroke outcome is possible, it would be interesting to identify a capillary glucose and blood pressure treshold predicting poor outcome that could serve as reference for starting corrective treatment. Methods : We conducted a prospective cohort study of 80 first-ever acute ischemic stroke patients. All patients underwent measurement of capillary blood glucose level on admission and 2 times in first 24 hours of admission, and measurement of blood pressure on admission and 4 times in 24 hours of admission. Poor outcome (modified Rankin Scale >3) was evaluated at day 90th• Results: Subjects consists of 37 (46.3%) male and 43 (53.75%) female, with mean age of 60.38 years. The receiver operating characteristic showed the predictive value of initial capillary glucose level with an area under the curve 0,608 (95%CI, 0,432 to 0,783), and pointed 137 mg/di as the optimal cut-off level for poor outcome at 3 months (63% sensitivity, 59% specificity), associated with increased in odds 1,3-fold (95%CI, 0.930-1.809, p=0.116), while maximal capillary glucose level with an area under the curve 0.635 (95%CI, 0,435 to 0.694, p=0.130), and pointed 156 mg/di as the optimal cut-off level (74% sensitivity, 55% specificity), associated with increased in odds 1.3-fold (95%CI, 0.904-1.877). The receiver operating characteristic showed the predictive value of mean systolic blood pressure during 24 hours of admission with an area under the curve 0.545 (95%CI, 0.410-0.680) and pointed 149 mmHg as the optimal cut-off level for poor outcome at 3 months, and associated with increased in odds 1.1-fold (95%CI, 0.802-1.575, p=0.490) while mean diastolic blood pressure showed an area under the curve 0.568 (95%CI, 0.435-0.701) and pointed 89 mmHg as optimal cut-off level (58% sensitivity and 54% specificity) for poor outcome and associated with increased in odds 1.1-fold (96%CI, 0.783-1.503, p=0.311). Conclusions : Capillary blood glucose~ 137 mg/di at baseline, ~156 mg/di at any time within 24 hours of admission and mean systolic blood pressure >-149 mmHg and mean diastolic blood pressure >-89 mmHg in acute ischemic stroke associated with poor outcome at day 90th, but this results was not statistically significant.