Hyperglycemia and free radical imbalance as prognostic factors in acute stroke

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Abstract

We evaluated 395 patients with acute stroke: diabetes mellitus was diagnosed in 19.5%, hyperglycemia was observed in 41.8% patients on day 1 and in 48.9% on day 2 after admission. Hyperglycemia and diabetes were associated with more severe free radical imbalance and worsened the outcome in stroke patients, decreasing
rehabilitation potential. The increase of malonic dialdehyde (MDA), decrease of antiperoxide plasma activity (APA), hyperglycemia and high leucocyte count are shown to be prognostic factors of adverse outcome (death, severe disability), which should be taken into account during antioxidant therapy. The highest mortality rate, which showed correlation with the size of stroke, was observed in patients with hyperglycemia persisting more than 3 days after stroke onset, and it was 1.8-fold higher than in patients with normoglycemia. Indications for target antioxidant therapy are: blood glucose > 6.6 mmol/l, leucocyte count >9 700, APC level <3, and MDA level >4 μmol/l

About the authors

S. A. Rumyantceva

Russian National Research Medical University named after N.I. Pirogov

Author for correspondence.
Email: silinaekaterina@mail.ru
Russian Federation, Moscow

E. V. Silina

First Moscow State Medical University named after I.M. Sechenov

Email: silinaekaterina@mail.ru
Russian Federation, Moscow

A. S. Orlova

First Moscow State Medical University named after I.M. Sechenov

Email: silinaekaterina@mail.ru
Russian Federation, Moscow

V. A. Orlov

First Moscow State Medical University named after I.M. Sechenov

Email: silinaekaterina@mail.ru
Russian Federation, Moscow

S. B. Bolevich

First Moscow State Medical University named after I.M. Sechenov

Email: silinaekaterina@mail.ru
Russian Federation, Moscow

References

  1. Григорян И.Г., Густов А.В., Стронгин Л.Г., Беляева Н.Г. Интенсивный гликемический контроль в первые сутки острого нарушения мозгового кровообращения у больных сахарным диабетом 2-го типа. Журн. неврол. и психиатрии им. С.С. Корсакова. Приложение «Инсульт» 2012; 3: 7–9.
  2. Гусев Е.И., Скворцова Л.В., Стаховская Л.В. Проблема инсуль- та в Российской Федерации: время активных совместных дей- ствий. Журн. неврол. и психиатрии им. С.С. Корсакова 2007; 8: 4–10.
  3. Евзельман М.А., Макеева М.А. Течение острого ишемического инсульта у больных с нарушением углеводного обмена. Журн. неврол. и психиатрии им. С.С. Корсакова 2012; 2: 64–66.
  4. Очерки ангионеврологии (под. ред. З.А. Суслиной). М.: Атмосфера, 2005.
  5. Румянцева С.А., Федин А.И., Болевич С.Б., Силина Е.В. Свободнорадикальные процессы и их коррекция при геморраги- ческом инсульте. Неврол. журн. 2007; 5: 51–56.
  6. Allen C.L., Bayraktutan U. Oxidative stress and its role in the pathogenesis of ischaemic stroke. Int. J. Stroke 2009; 4: 461–470.
  7. Barth E., Albuszies G., Baumgart K. et al. Glucose metabolism and catecholamines. Crit. Care Med. 2007; 35 (Suppl. 9): 508–518.
  8. Gearhart M.M., Parbhoo S.K. Hyperglycemia in the critically ill patient. AACN Clin. Issues 2006; 17: 50–55.
  9. Graham J.E., Ripsin C.M., Deutsch A. et al. Relationship between diabetes codes that affect Medicare reimbursement (tier comorbidities) and outcomes in stroke rehabilitation. Arch. Phys. Med. Rehabil. 2009; 90: 1110–1116.
  10. Kamada H., Yu F., Nito C., Chan P.H. Influence of hyperglycemia on oxidative stress and matrix metalloproteinase- 9 activation after focal cerebral ischemia/reperfusion in rats: relation to blood-brain barrier dysfunction. Stroke 2007; 38: 1044–1049.
  11. Mattson M.P., Duan W., Pedersen W.A., Culmsee C. Neurodegenerative disorders and ischemic brain diseases. Apoptosis 2001; 6: 69–81.
  12. Plomgaard P., Bouzakri K., Krogh-Madsen R. et al. Tumor necrosis factor-α induces skeletal muscle insulin resistance in healthy human subjects via inhibition of Akt substrate 160 phosphorylation. Diabetes 2005; 54: 2939–2945.
  13. Polidori M.C., Frei B., Cherubini A. et al. Increased plasma levels of lipid hydroperoxides in patients with ischemic stroke. Free Radic. Biol. Med. 1998; 25: 561–567.
  14. Ripley D.L., Seel R.T., Macciocchi S.N. et al. The impact of diabetes mellitus on stroke acute rehabilitation outcomes. Am. J. Phys. Med. Rehabil. 2007; 86: 754–761.
  15. Stöllberger C., Exner I., Finsterer J. et al. Stroke in diabetic and nondiabetic patients: course and prognostic value of admission serum glucose. Ann. Med. 2005; 37: 357–364.
  16. Van den Berghe G. Novel insights into the neuroendocrinology of critical illness. Eur. J. Endocrinol. 2000; 143: 1–13.
  17. Vanhorebeek I., Langouche L., van den Berghe G. Endocrine aspects of acute and prolonged critical illness. Nat. Clin. Pract. Endocrinol. Metab. 2006; 2: 20–31.

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Copyright (c) 2012 Rumyantceva S.A., Silina E.V., Orlova A.S., Orlov V.A., Bolevich S.B.

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