Prevalence Of Stress Hyperglycemia And Prognosis In Adult Patients Admitted With Acute Stroke (Ischemic & Hemorrhagic) In Medical Wards Of Jimma University Specialized Hospital, Jimma Town, Southwest Ethiopia.

Abstract

Background: Stroke is the second most common cause of disability and death worldwide in adults. The incidence of stroke increases with age, and the number of strokes is projected to increase. The exact burden of stroke is not known in Africa as well as in sub-Saharan Africa. While developed countries experience a decline in stroke incidence and mortality rates, the problem is increasing in sub-Saharan Africa. The burden of stoke in Ethiopia is not clearly known but some hospital studies have shown that stroke is an important cause of morbidity and mortality. Stress hyperglycemia is one of the factors that can affect the prognosis of patients with stoke. Objective: To determine the prevalence of stress hyperglycemia and prognosis in adult patients admitted with acute stoke to Jimma University Specialize Hospital medical wards from 1st December, 2013 to April 31, 2014 Methods: A hospital based prospective cross sectional study was conducted through patient interview and chart review using structured check list for patients admitted to Jimma University Specialize Hospital medical wards from 1st December, 2013 to April 31, 2014. Data was obtained from 85 patients admitted with a diagnosis of stroke and blood samples were collected to determine the admission blood glucose level. The data was organized, coded, entered, cleaned, and analyzed using SPSS version 16.0. Descriptive statistics and binary logistic regression analysis were done. A P-value of <0.05 was considered statistically significant. Results: Data collected from 80 acute stroke patients were included in the analysis. Forty eight (60%) of them were males. the prevalence of stress hyperglycemia is 66%.The mean age of the study subjects was 55.9 + 14.4; 40(50%) were above the age of 60 years. Thirty eight (47.5%), 19(23.8%), 5 (6.2%), 5 (6.2%), 2 (2.5%) of the respondents were farmers, housewife, government employee, merchants and students respectively. The majority of the patients 50 (62.5%) were from rural areas. The mean monthly income is 645 birr. Of the total 80 subjects in the study, 53 (66.2%) had admission stress hyperglycemia of which 33 were females. Of the total study subjects admitted with acute stroke to the hospital during the study period, 65 (81.2%) were discharged being improved and 15(18.8%) were dead. Forty four (55%) were admitted with in 24hrs of symptom onset and 74(92.5% ) of the patients stayed for 2 or more days in hospital ,the mean average hospital stay in days being 10.1 + 5.1 and the maximum and minimum hospital stay being 24 and 1day respectively. Of the 15(18.8%) patients who died the commonest immediate cause of death was respiratory arrest 9(11.2%) followed by multiple organ failure 3(3.8%) and sepsis 3(3.8%) respectively. Outcome of the patient is strongly associated with stress hyperglycemia; all of the 15 patients who died during the study period had stress hyperglycemia at admission.Forty four (55%) were admitted within 24hrs of symptom onset &74(92.5% ) of the patients stayed for 2 or more days in hospital ,the mean average hospital stay in days being 10.1 + 5.1 and the maximum and minimum hospital stay being 24 and 1day respectively. The associations of hospital stay with stress hyperglycemia also revealed in this study with a p-value of 0.069.presence of stroke risk factors donot have strong association with stress hyperglycemia Conclusion and Recommendation: this study found that the prevalence of Stress Hyperglycemia in acute Stroke patients is high and it has a poor prognostic implication in patient outcome. Therefore, understanding all pathways and developing specific therapies along with critical care of stroke patients with Stress Hyperglycemia, may reduce the mortality & morbidity, hence improve outcome & prognosis. Random Blood Sugar should be done for all patients with stroke and proper management of SH in stroke patients are mandatory for good patient outcome.