Abstract
Reduced intravascular volume upon ischemic stroke (IS) admission has been associated with in-hospital complications, disability, and reduced survival. We aimed to evaluate the association of the urea-to-creatinine ratio (UCR) with disability or death at discharge, length of stay, in-hospital complications, and mortality during the first year. Using a national registry, we identified hospitalized IS patients without renal failure. Disability or death at discharge, length of stay, in-hospital complications, and mortality during the first year were studied by UCR, and associations between UCR levels and each outcome were assessed adjusting for age, sex, stroke severity, comorbidities, use of statins, and use of diuretics. In total, 2212 patients were included. Levels (median (25–75%)) for the main study variables were: urea 5.16 (3.66–6.83) mmol/L; creatinine 80 (64–92) µmol/L; and UCR 65 (58–74). Levels of UCR were significantly higher in patients with disability or death at discharge (p < 0.0001), those with complications during hospitalization (p = 0.03), those with infection during hospitalization (p = 0.0003), and those dead at 1 year (p < 0.0001). Analysis by UCR quartile showed that rates of disability or death at discharge, infections, complications overall, and death at 1 year in patients with UCR in the 4th quartile were significantly higher than in others. Risk-factor-adjusted analysis by UCR quartiles demonstrated an inconsistent independent association between UCR and disability or death after ischemic stroke. A high 1-year mortality rate was observed in IS patients with elevated UCR, yet this finding was not statistically significant after controlling for risk factors. Our study shows inconsistent associations between hydration status and poor functional status at discharge, and no association with length of stay, in-hospital complications (infectious and overall), and 1-year mortality.
Highlights
Reduced intravascular volume, commonly referred to as dehydration, is a common finding upon admission of patients with ischemic stroke (IS), reported in 29–70% of patients [1]
Using data from the National Acute Stroke Israeli Survey (NASIS) registry of hospitalized stroke patients, we aimed to evaluate the association of hydration status in IS, as measured by urea/creatinine ratio (UCR), with stroke severity on admission, in-hospital complications, and mortality during the first year after ischemic stroke
Severe stroke was reported for 8.4% of patients, while 65.6% were diagnosed with minor stroke (NIHSS ≤ 5)
Summary
Commonly referred to as dehydration, is a common finding upon admission of patients with ischemic stroke (IS), reported in 29–70% of patients [1]. It has been associated with in-hospital complications [2,3,4,5,6,7,8,9], poor functional outcome at discharge [4,10,11], poor functional outcome at 30 days [12], and reduced survival at 90 days [13,14]. Using data from the National Acute Stroke Israeli Survey (NASIS) registry of hospitalized stroke patients, we aimed to evaluate the association of hydration status in IS, as measured by UCR, with stroke severity on admission, in-hospital complications, and mortality during the first year after ischemic stroke
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