Association between Plasma Osmolality and Case Fatality within 1 Year after Severe Acute Ischemic Stroke

Abstract

Purpose Plasma osmolality, a marker of dehydration, is associated with cardiovascular mortality. We aimed to investigate whether elevated plasma osmolality is associated with case fatality within 1 year after severe acute ischemic stroke. Materials and Methods We included severe ischemic stroke patients (defined as National Institutes of Health Stroke Scale ≥15 score) within 24 hours from symptom onset admitted to the Department of Neurology, West China Hospital between January 2017 and June 2019. Admission plasma osmolality was calculated using the equation 1.86*(sodium+potassium)+1.15*glucose+urea+14. Elevated plasma osmolality was defined as plasma osmolality >296 mOsm/kg, indicating a state of dehydration. Study outcomes included 3-month and 1-year case fatalities. Multivariable logistic regression was performed to determine independent associations between plasma osmolality and case fatalities at different time points. Results A total of 265 patients with severe acute ischemic stroke were included. The mean age was 71.2±13.1 years, with 51.3% being males. Among the included patients, case fatalities were recorded for 31.7% (84/265) at 3 months and 39.6% (105/265) at 1 year. Elevated plasma osmolality (dehydration) was associated with 3-month case fatality [odds ratio (OR) 1.98, 95% confidence interval (CI) 1.07–3.66, p =0.029], but not 1-year case fatality (OR 1.51, 95% CI 0.84–2.72, p =0.165), after full adjustment for confounding factors. Conclusion Elevated plasma osmolality was independently associated with 3-month case fatality, but not 1-year case fatality, for severe acute ischemic stroke.

The prevalence of chronic dehydration and associated with cardiometabolic risks among agriculture and aquaculture workers

“…This may be attributed to the use of different healthcare settings and methods to classify the dehydration status. Although serum osmolality is recommended the preferred biomarker for determining dehydration (22,27), however, due to the serum osmolarity changing over time due to water consumption, it is better to perform serial measurements to improve the consistency. Nevertheless, the conventional instruments for assessing dehydration from blood and urine samples are expensive and time-consuming; collecting blood and urine samples is inconvenient and not feasible for community adults in rural areas.…”

“…Dehydration was measured by plasma osmolarity and pOsm ≥295 or ≥ 300 (mOsm/kg) was classified as impending or hyperosmolar dehydration (21,26,27). For every participant, blood samples were gathered in the early morning, specifically between 7 and 8 am, prior to their breakfast, following a fasting period of at least 8 h. This fasting interval only permitted water intake.…”

“…Recently, the direct measurement of plasma osmolarity (pOsm) has been recommended as a valuable marker for determining dehydration (24, 25). A pOsm >295 or > 300 mOsm/kg has been defined as impending or hyperosmolar dehydration (21,22,26,27). Osmolality indicates the concentration of all particles dissolved in body fluid (28, 29).…”