Cerebral infarction in diabetes: clinical pattern, stroke subtypes, and predictors of in-hospital mortality.
BACKGROUND
To compare the characteristics and prognostic features of ischemic stroke in patients with diabetes and without diabetes, and to determine the independent predictors of in-hospital mortality in people with diabetes and ischemic stroke.


METHODS
Diabetes was diagnosed in 393 (21.3%) of 1,840 consecutive patients with cerebral infarction included in a prospective stroke registry over a 12-year period. Demographic characteristics, cardiovascular risk factors, clinical events, stroke subtypes, neuroimaging data, and outcome in ischemic stroke patients with and without diabetes were compared. Predictors of in-hospital mortality in diabetic patients with ischemic stroke were assessed by multivariate analysis.


RESULTS
People with diabetes compared to people without diabetes presented more frequently atherothrombotic stroke (41.2% vs 27%) and lacunar infarction (35.1% vs 23.9%) (P < 0.01). The in-hospital mortality in ischemic stroke patients with diabetes was 12.5% and 14.6% in those without (P = NS). Ischemic heart disease, hyperlipidemia, subacute onset, 85 years old or more, atherothrombotic and lacunar infarcts, and thalamic topography were independently associated with ischemic stroke in patients with diabetes, whereas predictors of in-hospital mortality included the patient's age, decreased consciousness, chronic nephropathy, congestive heart failure and atrial fibrillation


CONCLUSIONS
Ischemic stroke in people with diabetes showed a different clinical pattern from those without diabetes, with atherothrombotic stroke and lacunar infarcts being more frequent. Clinical factors indicative of the severity of ischemic stroke available at onset have a predominant influence upon in-hospital mortality and may help clinicians to assess prognosis more accurately.
Arboix
Adrià
A
Cerebrovascular Division, Department of Neurology, Hospital del Sagrat Cor, Universitat de Barcelona, Viladomat 288, E-08029 Barcelona, Spain. aarboix@hscor.com
Rivas
Antoni
A
García-Eroles
Luis
L
de Marcos
Lourdes
L
Massons
Joan
J
Oliveres
Montserrat
M
D000368:Aged; D000369:Aged, 80 and over; D002544:Cerebral Infarction / Q000145:classification / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D016009:Chi-Square Distribution; D003710:Demography; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012189:Retrospective Studies; D012196:Review Literature as Topic; D012307:Risk Factors