Letter by Choudhary et al Regarding Article, “Admission Hyperglycemia and Poor Outcomes in Cerebral Venous Thrombosis”
To the Editor:
In their article, “Admission Hyperglycemia and Clinical Outcome in Cerebral Venous Thrombosis,” Zuurbier et al has highlighted the adverse effects of raised blood glucose at admission on the clinical outcomes of cerebral venous thrombosis.1
In their endevor to improve the precision of the results, the patients with history of diabetes mellitus were excluded from the study population. However, there was no objective method or biomarkers like glycohemoglobin, glycated albumin, or fructosamine that were estimated to diagnose such patients.2 This might have resulted in the inclusion of patients with diabetes mellitus in the study group who are unaware of their disease.
Further, both the study groups had patients with previous thrombotic risks (see Table 1 from Zuurbier et al1), but there is no mention of the use of prior anticoagulation in these patients, which might have pertinent bearing on the outcomes.
We are sceptical about the odds of poor outcome associated with hyperglycemia if the analysis excluded deaths (modified Rankin Scale score 6) from the dichotimized (modified Rankin Scale score 0–2 versus 3–6) because deaths have also been separately analyzed (see Table 2 from Zuurbier et al1). These limitations might lead to altered results, and the poor outcomes associated with hyperglycemia could be fortuitous.
Aditya Choudhary, MD
Amith Kumar S, MD
Dheeraj Khurana, MD, DM
Department of Neurology
Post Graduate Institute of Medical Education and Research
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