Abstract
BackgroundMany studies have determined that dehydration is an independent predictor of outcome after ischemic stroke (IS); however, none have determined if the use of thrombolytic therapy modifies the negative impact of poor hydration. To inform the stroke registry established at our institution, we conducted a retrospective study to determine if dehydration remains a negative prognostic factor after IS patients treated with tissue plasminogen activator (tPA).MethodsBetween 2007 and 2012, we recruited 382 subjects; 346 had data available and were divided into 2 groups on the basis of their blood urea nitrogen/creatinine (BUN/Cr) ratio. Dehydrated subjects had a BUN/Cr ratio ≥ 15; hydrated subjects had a BUN/Cr < 15. The primary outcome was impairment at discharge as graded by the Barthel Index (BI) and the modified Rankin Scale (mRS).ResultsThe dehydration group had a greater mean age; more women; lower mean levels of hemoglobin, triglycerides, and sodium; and higher mean potassium and glucose levels. A favorable outcome as assessed by the mRS (≤2) was significantly less frequent among dehydrated subjects, but a favorable outcome by the BI (≥60) was not. Logistic regression and multivariate models confirmed that dehydration is an independent predictor of poor outcome by both the mRS and the BI; however, it was not predictive when patients were stratified by Trial of Org 10,172 in Acute Stroke Treatment subtype.ConclusionsOur findings indicate that use of thrombolytic therapy does not eliminate the need to closely monitor hydration status in patients with IS.
Highlights
Many studies have determined that dehydration is an independent predictor of outcome after ischemic stroke (IS); none have determined if the use of thrombolytic therapy modifies the negative impact of poor hydration
Characteristics of subjects with and without dehydration A total of 382 subjects were included in this study
We determined that an increased blood urea nitrogen (BUN)/Cr ratio was associated with a bad prognosis at discharge as assessed by both the modified Rankin Scale (mRS) and the Barthel Index (BI)
Summary
Many studies have determined that dehydration is an independent predictor of outcome after ischemic stroke (IS); none have determined if the use of thrombolytic therapy modifies the negative impact of poor hydration. In 2000, Bhalla and colleagues conducted one of the first investigations of the effects of dehydration on outcomes after IS and found that 3-month survivors had lower plasma osmolality than did non- survivors [15]. This finding was supported by Kelly et al, who in 2004 reported that dehydration was associated with a higher risk of venous thromboembolism [16]. The data suggest that hydration therapy should be a central feature of stroke management, and recent guidelines acknowledge this [27]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
