Fluid Balance Variations During the Early Phase of Large Hemispheric Stroke Are Associated With Patients' Functional Outcome

Abstract

Background: From the variety of factors underlying the ischemia-associated edema formation in large hemispheric stroke (LHS), an increased brain water content during the early phase seems to have a pivotal role for long-lasting tissue damage. However, the importance of the fluid management during the acute phase of LHS has so far not been adequately studied. Therefore, this study explored the association between the fluid balance and functional outcome in patients suffering from LHS. Methods: We analyzed hospital-based medical records of 39 consecutive patients with LHS and decompressive hemicraniectomy. Over the first 10 days after admission, the volumes of all administered fluids were assessed daily and corrected for daily urinary output and insensible loss. Functional outcome at 3 months was assessed with the modified Rankin Scale (mRS) and dichotomized into an acceptable (mRS ≤ 4) vs. a poor outcome (mRS ≥ 5). Results: Compared to patients with a poor functional outcome ( n = 19), those with an acceptable outcome ( n = 20) were characterized by a significantly lower cumulative net fluid balance at day 5 (1.6 ± 2.5 vs. 3.4 ± 4.4 l), day 7 (2.0 ± 2.9 vs. 4.6 ± 5.2 l), and day 10 (0 ± 2.5 vs. 5.6 ± 6.2 l). In addition to age, only the cumulative net fluid balance at day 10 served as an independent factor for poor functional outcome in multiple regression analyses. Conclusion: These data provide evidence for a critical role of the early phase net fluid balance with respect to the functional outcome after LHS. This observation leads to the hypothesis that patients with LHS might benefit from a more restrictive volume therapy. However, prospective studies are warranted to establish a causal relationship and recommendations for treatment strategies.

Effects of admission systemic inflammatory indicators on clinical outcomes in patients with vertebrobasilar artery occlusion: insight from the PERSIST registry

“…However, in patients with ac-LVO who received EVT, the value of W ranged from 7.3 to 10×10 9 , N from 4.9 to 8×10 9 , and NLR ranged from 2.8 to 7.3 21 22. The numerical discrepancy might be attributed to the following reasons: (1) compared with patients with ac-LVO, VBAO patients are in a critical condition with severe symptoms and have a strong stress response, which activates the sympathetic adrenal medulla system, leading to increased sympathetic excitability, increased catecholamine release, and a strong inflammatory response2 23; (2) VBAO patients tend to experience a higher risk of aspiration, which may aggravate the inflammatory response immediately before EVT24 25; and (3) the vertebrobasilar artery area contains the majority of the neuroendocrine axis components. Thus VBAO is more likely to have an impact on the hypothalamic‒pituitary‒adrenaline axis, which in turn will inhibit the immune system and increase the risk of infection 26…”

Net Water Uptake Calculated in Standardized and Blindly Outlined Regions of the Middle Cerebral Artery Territory Predicts the Development of Malignant Edema in Patients With Acute Large Hemispheric Infarction

“…There have been several studies exploring valid predictors of ME in LHI patients, such as the National Institutes of Health Stroke Scale (NIHSS), presence of hyperdense artery sign, a higher level of blood glucose, decreased level of consciousness, early infarct signs, intracranial cerebrospinal fluid volume, fluid balance variations, collateral circulation (10)(11)(12)(13)(14)(15)(16)(17).…”