Analysis of acute stroke complications in diabetic patients
Background. The presence of diabetes mellitus (DM) worsens the course of stroke, increases the risk of complications and death. The complication of acute stroke (AS) is one of the causes that only 60–70 % of cases of AS are typical. The purpose was to analyze the incidence and features of acute stroke complications in patients with diabetes and other disorders of carbohydrate metabolism. Materials and methods. Retrospectively, in the archives, 416 disease histories of patients with a verified acute stroke treated at the intensive care units in 2010–2013 were analysed. Patients with AS were divided in three groups: 1) pre-existing DM, 2) newly diagnosed diabetes DM and 3) patients without diabetes. The incidence of complications, their severity, the peculiarities of their course, their ability to be treated and the need for optimization of therapies were analysed. The patients were aged 31 and 92 years, had average height and increased body weight (body mass index ranged from 26.0 to 29.4 kg/m2). There were no statistically significant differences in the general and anthropometric indices between patients of different groups. Results. The most frequent complication in patients of all groups (within 65.5–68.8 %) was fever. In some patients, fever occurred in the first 24 hours (27 patients, 6.5 %) and correlated with the severity of clinical manifestations of AS (direct dependence). In some patients, fever has arisen from the 3rd day and did not depend on the volume and severity of the defeat, but was associated with the emergence of infectious centres (pneumonia, diabetic foot syndrome, etc.). Respiratory disorders have also been observed in many patients with AS in all groups. The most common causes of tracheal intubation and transfer to mechanical ventilation were the ineffectiveness of external respiration and depression of consciousness below 8 points on Glasgow Coma Scale. The time of the start of mechanical ventilation ranged from 0 hours (at admission) to 4–5 days. In 26 cases (6.25 %), the patients needed urgent intubation and transfer to mechanical ventilation. Attention is drawn to the high mortality of the patients with mechanical ventilation (about 33.7 %) indicating both the severity of the injury and the depth of consciousness impairment. At the same time, there is a need to improve the traditional approaches to respiratory support in this category of intensive care patients. Documentary (X-ray) confirmed pneumonia was reported in 24 (5.8 %) patients in general. In patients with AS against a background of diabetes, pneumonia occurred reliably earlier (1–2 days). Disturbances in the exchange of major electrolytes have occurred in patients with AS quite often. In general, one or another type of electrolyte impairment was detected in 73.9 % of cases (258 out of 349). Moreover, in patients with DM, the incidence of electrolyte disturbances was significantly higher than in patients without diabetes: 82 (81.2 %) and 36 (83.7 %) patients of the 1st and 2nd groups, respectively, and 134 (65.4 %) in the control group (p < 0.05). The imbalance in sodium and potassium exchange was most common. Thus, hypokalemia (K+ level < 3.5 mmol/l) occurred in 35.7 % of patients with pre-existing DM and in 37.2 % of patients with newly diagnosed DM, whereas in patients without DM, it was detected only 15.1 % cases. The most frequent urgent condition in the studied cohort was diabetic ketoacidosis, which developed in 19 patients (4.56 %). But on the background of timely diagnosis and adequate treatment, the carbohydrate metabolism disorders were not catastrophic. In particular, the average level of glycemia in these patients rarely exceeded 20 mmol/l. In 168 patients (40.38 %), there was short-term hyperglycemia. In 139 out of 168 patients, who observed single episodes of hyperglycemia (up to 11.1 mmol/l) upon admission, these were indeed manifestations of transient, or stress, hyperglycemia. In 18 patients, diabetes was not diagnosed in time, and 11 patients had missed conditions of pre-diabetes — impaired glucose tolerance or hyperglycemia. Thus, in 29 patients, diabetes mellitus and pre-diabetes were not detected. Conclusions. The course of AS in patients with newly diagnosed diabetes is more severe, and complications develop more often than in patients with pre-existing diabetes or without diabetes. In 48 individuals (11.5 % of all patients with AS), complications of carbohydrate metabolism were detected for the first time. Timely diagnosis of diabetes and of other disorders of carbohydrate metabolism helps to determine the rational program of intensive care and to avoid unwanted complications.
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