Diabetes mellitus como fator prognóstico em doença cerebrovascular isquêmica

Oliveira, Terezinha V.; Gorz, Ana Marlene; Bittencourt, Paulo Rogério M.

doi:10.1590/S0004-282X1988000300009

Resumos

Como parte de estudo prospectivo de 347 casos de doença cerebrovascular isquêmica (DCVI) internados em um hospital geral, foram avaliados 36 pacientes diabéticos e 36 controles com sexo, idade e pressão arterial semelhantes, com o objetivo de verificar como diabetes mellitus afeta o prognóstico em DCVI. Os 72 pacientes apresentavam vários tipos de DCVI (trombose, tromboembolismo ou embolia cardiogênica). Os pacientes diabéticos tiveram estatisticamente mais dias de internamento (p<0,05), mais complicações durante o internamento (p<0,05), mais complicações infecciosas (p<0,01) e maior número de óbitos ao fim do seguimento (p<0,05). Após 377 ±429 (média ± desvio padrão) dias de seguimento, em 50% dos diabéticos havia ocorrido o óbito, enquanto após 387±405 dias 25% dos não diabéticos haviam falecido. Os óbitos em ambos os grupos ocorreram em média no oitavo mês após o evento vascular que motivou a admissão inicial. Não foram notadas diferenças com respeito ao número de óbitos durante a internação inicial ou as condições neurológicas dos sobreviventes ao fim da admissão inicial e do seguimento.

As part of a prospective study about 347 cases of ischemic cerebral vascular disease (DCVI) admitted to a general hospital 36 diabetic and 36 non-diabetic patients with similar sex, age and blood pressure were evaluated with the objective of assessing the effect of diabetes mellitus on prognosis in DCVI. All patients had various types of DCVI (thrombosis, thromboembolism or cardiac embolism). The diabetic patients had statisticaly longer admissions (p<0.05), more complications during remission (p<0.05), more infectious complications (p<0.01) and a greater number of deaths at the end of follow-up (p<0.05). After 377+429 (mean ± standard deviation) days of follow-up, 50% of the diabetics had died while after 387±405 days 25% of the non-diabetics had died. Deaths in both groups occured in average at the 8th month after the vascular event that led to the first admission. There were no differences with respect to the number of deaths during admission or to neurological conditions of the survivors at the end of the first admission or at the end of follow-up.

Terezinha V. Oliveira^I; Ana Marlene Gorz^II; Paulo Rogério M. Bittencourt^III

^IMédica Residente - Unidade de Neurologia Clínica, Hospital Nossa Senhora das Graças (HNSG), Curitiba

^IINeurologista - Unidade de Neurologia Clínica, Hospital Nossa Senhora das Graças (HNSG), Curitiba

^IIIChefe da Unidade - Unidade de Neurologia Clínica, Hospital Nossa Senhora das Graças (HNSG), Curitiba

RESUMO

Como parte de estudo prospectivo de 347 casos de doença cerebrovascular isquêmica (DCVI) internados em um hospital geral, foram avaliados 36 pacientes diabéticos e 36 controles com sexo, idade e pressão arterial semelhantes, com o objetivo de verificar como diabetes mellitus afeta o prognóstico em DCVI. Os 72 pacientes apresentavam vários tipos de DCVI (trombose, tromboembolismo ou embolia cardiogênica). Os pacientes diabéticos tiveram estatisticamente mais dias de internamento (p<0,05), mais complicações durante o internamento (p<0,05), mais complicações infecciosas (p<0,01) e maior número de óbitos ao fim do seguimento (p<0,05). Após 377 ±429 (média ± desvio padrão) dias de seguimento, em 50% dos diabéticos havia ocorrido o óbito, enquanto após 387±405 dias 25% dos não diabéticos haviam falecido. Os óbitos em ambos os grupos ocorreram em média no oitavo mês após o evento vascular que motivou a admissão inicial. Não foram notadas diferenças com respeito ao número de óbitos durante a internação inicial ou as condições neurológicas dos sobreviventes ao fim da admissão inicial e do seguimento.

SUMMARY

As part of a prospective study about 347 cases of ischemic cerebral vascular disease (DCVI) admitted to a general hospital 36 diabetic and 36 non-diabetic patients with similar sex, age and blood pressure were evaluated with the objective of assessing the effect of diabetes mellitus on prognosis in DCVI. All patients had various types of DCVI (thrombosis, thromboembolism or cardiac embolism). The diabetic patients had statisticaly longer admissions (p<0.05), more complications during remission (p<0.05), more infectious complications (p<0.01) and a greater number of deaths at the end of follow-up (p<0.05). After 377+429 (mean ± standard deviation) days of follow-up, 50% of the diabetics had died while after 387±405 days 25% of the non-diabetics had died. Deaths in both groups occured in average at the 8th month after the vascular event that led to the first admission. There were no differences with respect to the number of deaths during admission or to neurological conditions of the survivors at the end of the first admission or at the end of follow-up.

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1. Asplund K, Hägg E, Helmers C, Lithner F, Strand T, Wester PO - The natural history of stroke in diabetic patients. Acta Med Scand 207: 417, 1980.
2. Caplan LR, D'Cruz I, Hier BD, Reddy H, Shah S - Atrial size, atrial fibrillation and stroke. Ann Neurol 19: 158, 1986.
3. Courten-Myers GM, Yamaguchi S, Wagner KR, Ting P, Myers RE - Brain injury from marked hipoxia in cats: role of hypotension and hyperglycemia. Stroke 16: 1016, 1985.
4. Cox NH, Lorains JW - The prognostic value of blood glucose and glycosylated haemoglobin estimation in patients with stroke. Postgrad Med J 62 :7, 1986.
5. Fuller JH, Shipley MJ, Rose G, Jarrett RJ, Keen H - Mortality from coronary heart disease and stroke in relation to degree of glycaemia: the Whitehall study. Br Med J 287: 867, 1983.
6. Garcia MJ ,MacNamara PM, Gordon T, Kannell WB - Morbidity and mortality in diabetics in the Framingham population. Diabetes 23: 105, 1974.
7. Hart RG, Coull BM, Hart D - Early recurrent embolism associated with nonvalvular atrial fibrillation: a retrospective study. Stroke 14: 688, 1983.
8. Herman B, Leyten ACM, Van Luuk JH, Frenken CWGM, Op De Coul AAW, Schulte BPM - An evaluation of risk factors for stroke in a Dutch community. Stroke 13: 334, 1982.
9. Kagan A, Popper JS, Rhoads GG, Yano K - Dietary and other risk factors for stroke in Hawaiian Japanese men. Stroke 16: 390, 1985.
10. Kagan A, Popper JS, Rhoads GG - Factors related to stroke incidence in Hawaii Japanese men: the Honolulu heart study. Stroke 11:14, 1980.
11. Kuller LH, Dorman JS, Wolf PA - Cerebrovascular disease and diabetes. In United States Department of Health and Human Services: Diabetes in America. Washington, 1985, cap 18, pg 1.
12. Lavy S, Melamed E, Cahane E, Carmon A - Hypertension and diabetes as risk factors in stroke patients. Stroke 4: 751, 1973.
13. Mohr JP, Caplan LR, Melski JW, Goldstein RJ, Duncan GW, Kistler JP, Pessin MS, Bleich HL - The Harvard cooperative stroke registry: a prospective registry. Neurology 28: 754, 1978.
14. Olivares L, Catañeda E, Grifé A, Alter M - Risk factors in stroke: a clinical study in Mexican patients. Stroke 4 :773, 1973.
15. Palumbo PJ, Elveback LR, Chu-Pin Chu MS, Connolly DC, Kurland LT - Diabetes mellitus: incidence, prevalence, survirorship and causes of death in Rochester, Minnesota, 1945-1970. Diabetes 25: 566, 1979.
16. Pulsinelli WA, Levy DE, Sigsbee B, Scherer P, Plum F - Increased damage after ischemic stroke in patients with hyperglycemia with or without established diabetes mellitus. Am J Med 74: 540, 1983.
17. Riddle MC, Hart J - Hyperglycemia, recognized and unrecognized, as a risk factor for stroke and transient ischemic attacks. Stroke 13: 356, 1982.
18. Salonen JT, Pekka Puska MPH, Jaakko Tuomilehto MA, Kava Homan MA - Relation of blood pressure, serum lipids and smoking to the risk of cerebral stroke: a longitudinal study in Eastern Finland. Stroke 13: 327, 1982.
19. Sherman DG, Goldman L, Whiting RB, Jurgensen K, Kaste M, Easton JD - Trombo-embolism in patients with atrial fibrillation. Arch Neurol 41: 708, 1984.
20. Tso-Lin C, Bittencourt PRM, Gorz AM, Mazer S - Doença cérebro vascular isquêmica:estudo prospectivo de 347 casos num hospital geral. Tema Livre. 12ş Congresso Brasileiro de Neurologia, 1986.
21. Wolf PA - Risk factors for stroke (Editorial). Stroke 3: 359. 1985.

Diabetes mellitus como fator prognóstico em doença cerebrovascular isquêmica

Diabetes mellitus effect on prognosis in ischemic cerebral vascular disease

Datas de Publicação

Publicação nesta coleção
17 Jun 2011
Data do Fascículo
Set 1988

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Asplund K, Hägg E, Helmers C, Lithner F, Strand T, Wester PO - The natural history of stroke in diabetic patients. Acta Med Scand 207: 417, 1980.

[2] 2. Caplan LR, D'Cruz I, Hier BD, Reddy H, Shah S - Atrial size, atrial fibrillation and stroke. Ann Neurol 19: 158, 1986.

[3] 3. Courten-Myers GM, Yamaguchi S, Wagner KR, Ting P, Myers RE - Brain injury from marked hipoxia in cats: role of hypotension and hyperglycemia. Stroke 16: 1016, 1985.

[4] 4. Cox NH, Lorains JW - The prognostic value of blood glucose and glycosylated haemoglobin estimation in patients with stroke. Postgrad Med J 62 :7, 1986.

[5] 5. Fuller JH, Shipley MJ, Rose G, Jarrett RJ, Keen H - Mortality from coronary heart disease and stroke in relation to degree of glycaemia: the Whitehall study. Br Med J 287: 867, 1983.

[6] 6. Garcia MJ ,MacNamara PM, Gordon T, Kannell WB - Morbidity and mortality in diabetics in the Framingham population. Diabetes 23: 105, 1974.

[7] 7. Hart RG, Coull BM, Hart D - Early recurrent embolism associated with nonvalvular atrial fibrillation: a retrospective study. Stroke 14: 688, 1983.

[8] 8. Herman B, Leyten ACM, Van Luuk JH, Frenken CWGM, Op De Coul AAW, Schulte BPM - An evaluation of risk factors for stroke in a Dutch community. Stroke 13: 334, 1982.

[9] 9. Kagan A, Popper JS, Rhoads GG, Yano K - Dietary and other risk factors for stroke in Hawaiian Japanese men. Stroke 16: 390, 1985.

[10] 10. Kagan A, Popper JS, Rhoads GG - Factors related to stroke incidence in Hawaii Japanese men: the Honolulu heart study. Stroke 11:14, 1980.

[11] 11. Kuller LH, Dorman JS, Wolf PA - Cerebrovascular disease and diabetes. In United States Department of Health and Human Services: Diabetes in America. Washington, 1985, cap 18, pg 1.

[12] 12. Lavy S, Melamed E, Cahane E, Carmon A - Hypertension and diabetes as risk factors in stroke patients. Stroke 4: 751, 1973.

[13] 13. Mohr JP, Caplan LR, Melski JW, Goldstein RJ, Duncan GW, Kistler JP, Pessin MS, Bleich HL - The Harvard cooperative stroke registry: a prospective registry. Neurology 28: 754, 1978.

[14] 14. Olivares L, Catañeda E, Grifé A, Alter M - Risk factors in stroke: a clinical study in Mexican patients. Stroke 4 :773, 1973.

[15] 15. Palumbo PJ, Elveback LR, Chu-Pin Chu MS, Connolly DC, Kurland LT - Diabetes mellitus: incidence, prevalence, survirorship and causes of death in Rochester, Minnesota, 1945-1970. Diabetes 25: 566, 1979.

[16] 16. Pulsinelli WA, Levy DE, Sigsbee B, Scherer P, Plum F - Increased damage after ischemic stroke in patients with hyperglycemia with or without established diabetes mellitus. Am J Med 74: 540, 1983.

[17] 17. Riddle MC, Hart J - Hyperglycemia, recognized and unrecognized, as a risk factor for stroke and transient ischemic attacks. Stroke 13: 356, 1982.

[18] 18. Salonen JT, Pekka Puska MPH, Jaakko Tuomilehto MA, Kava Homan MA - Relation of blood pressure, serum lipids and smoking to the risk of cerebral stroke: a longitudinal study in Eastern Finland. Stroke 13: 327, 1982.

[19] 19. Sherman DG, Goldman L, Whiting RB, Jurgensen K, Kaste M, Easton JD - Trombo-embolism in patients with atrial fibrillation. Arch Neurol 41: 708, 1984.

[20] 20. Tso-Lin C, Bittencourt PRM, Gorz AM, Mazer S - Doença cérebro vascular isquêmica:estudo prospectivo de 347 casos num hospital geral. Tema Livre. 12ş Congresso Brasileiro de Neurologia, 1986.

[21] 21. Wolf PA - Risk factors for stroke (Editorial). Stroke 3: 359. 1985.