Abstract W P53: Hydration After IV tPA Predicts Outcome for Acute Ischemic Stroke: A Substudy of THIRST-O

Abstract

Background and Objective: Dehydration is potentially a precipitating factor in patients at risk for stroke. Patients who suffer from acute ischemic attacks are warned not to become dehydrated. Early animal models and studies on dehydration were linked to the development of hypercoagulation and thrombus formation. Previous studies have looked deeper into the enzymatic reactions occurring in the coagulation cascade and discovered the role of dehydration in catalyzing thrombus formation. Our objective was to study the effect hydration has on outcomes after IV tPA as a sub-study of our previous work on the Hydration Influence on the Risk of Stroke Outcome (THIRST-O) study. Methods: We reviewed the laboratory findings, clinical exam and overall hydration status of all patients who received IV tPA for the treatment of acute ischemic stroke from 2011-2013 at a university affiliated comprehensive stroke center. SPSS Software Version 22 was used to obtain descriptive statistics with frequencies, and the Spearman’s rho correlation coefficients were determined. Higher BUN/Creatinine ratio and serum osmolarity were used as markers for dehydration and were compared with the NIH Stroke Scale at admission, at 24-hours and discharge. Modified Rankin Scale at discharge (DCmRS) was recorded Results: Of the 1,565 ischemic stroke patients evaluated, 188 received IV tPA, and 162 met study criteria. Patients were mostly female [n=85, 52.7%), with the mean age of 73.4 (SD= 13.6). Patients with higher initial and later serum osmolarity had higher initial, 24-hour and DCNIHSS as well as higher DCmRS (r=.196, r=.207, r=.247, r=.411; p<.01). The initial BUN/Creatinine ratio correlated well with the ratio before discharge (r=.450; p=.0001). Patients with elevated BUN/Creatinine ratios were significantly more likely to have higher initial NIHSS, 24-hour NIHSS, DCNIHSS and DCmRS (r= 235, .216, .324, .431; p<.01). Conclusion: Dehydrated patients with acute ischemic stroke who received IV tPA had significantly worse clinical presentations and outcome. Our study suggests patients who receive IV tPA should be well hydrated for a better outcome. Our data needs to be validated in larger, prospective trials.