Hyperglycemia as a predictor of stroke severity and prognosis: evaluating short-term outcomes in acute stroke patients

Background: One of the leading causes of mortality and disability worldwide is stroke, with its burden increasing significantly, particularly in low- and middle-income countries (LMICs). Hyperglycemia independent of diabetic status has been correlated with a poor outcome after a stroke in severity, poor nervous system recovery, and mortality. However, the extent to which stress hyperglycemia independently impacts stroke prognosis remains debated. This study aimed to evaluate the relationship between glycemic status at admission and stroke severity, short-term neurological recovery, and mortality outcomes. Additionally, we assess whether random blood sugar (RBS) or glycated hemoglobin (HbA1c) correlates more strongly with stroke severity. Methods: A hospital-based observational study was conducted on 80 acute stroke patients. Patients were categorized into euglycemic, diabetic, prediabetic, and stress hyperglycemic groups based on admission RBS and HbA1c levels. Stroke severity was assessed using the NIH Stroke Scale (NIHSS) on day 1 and day 7. The primary outcome was neurological recovery, and the secondary outcome was 7-day mortality. Results: Hyperglycemia was significantly associated with higher NIHSS scores at admission and poorer recovery at day 7 (p<0.01). The mortality rate was highest in diabetic and stress hyperglycemic patients (20% each, p<0.01). A stronger correlation was found between RBS and stroke severity (r=0.81) than HbA1c (r=0.52). Conclusions: Acute hyperglycemia is an independent predictor of stroke severity and poor short-term outcomes, emphasizing the need for early glucose monitoring and targeted intervention in stroke patients.