Pilot study of volume contracted state and hospital outcome after stroke

Bahouth, Mona N.; Gaddis, Andrew; Hillis, Argye E.; Gottesman, Rebecca F.

doi:10.1212/cpj.0000000000000419

Cited by 12 publications

(21 citation statements)

References 31 publications

(37 reference statements)

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“…Although dehydration is a risk factor of early neurological deterioration (END) after AIS (12)(13)(14), the effect of dehydration on outcome after ICH remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Admission Dehydration Is Associated With Significantly Lower In-Hospital Mortality After Intracerebral Hemorrhage

Gao

et al. 2021

Front. Neurol.

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Background and Purpose: Our aim was to investigate the frequency of dehydration at admission and associations with in-hospital mortality in patients with intracerebral hemorrhage (ICH).Methods: Data of consecutive patients with ICH between August 2015 and July 2019 from the China Stroke Center Alliance (CSCA) registry were analyzed. The patients were stratified based on the blood urea nitrogen (BUN) to creatinine (CR) ratio (BUN/CR) on admission into dehydrated (BUN/CR ≥ 15) or non-dehydrated (BUN/CR < 15) groups. Data were analyzed with multivariate logistic regression models to investigate admission dehydration status and the risks of death at hospital.Results: A total number of 84,043 patients with ICH were included in the study. The median age of patients on admission was 63.0 years, and 37.5% of them were women. Based on the baseline BUN/CR, 59,153 (70.4%) patients were classified into dehydration group. Patients with admission dehydration (BUN/CR ≥ 15) had 13% lower risks of in-hospital mortality than those without dehydration (BUN/CR < 15, adjusted OR = 0.87, 95%CI 0.78–0.96). In patients aged <65 years, admission dehydration was associated with 19% lower risks of in-hospital mortality (adjusted OR = 0.81, 95%CI 0.70–0.94. adjusted p = 0.0049) than non-dehydrated patients.Conclusion: Admission dehydration is associated with significantly lower in-hospital mortality after ICH, in particular, in patients <65 years old.

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“…Although dehydration is a risk factor of early neurological deterioration (END) after AIS (12)(13)(14), the effect of dehydration on outcome after ICH remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Admission Dehydration Is Associated With Significantly Lower In-Hospital Mortality After Intracerebral Hemorrhage

Gao

et al. 2021

Front. Neurol.

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“…As a clinical operational definition, however, END can actually be caused by distinctive pathophysiological mechanisms. For patients with mild stroke, the extension of symptomatic ischemia into previously asymptomatic oligemic tissue plays the most influential role (Alawneh et al, ); for patients with severe stroke, it may also involve vasogenic edema or hemorrhagic transformation. Recent studies revealed that dehydration status was associated with the development of END (Bhatia et al, ; Lin, Fann, et al, ) and that hydration therapy based on dehydration assessment could prevent END and improve functional outcomes (Lin et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…For severe stroke with a large infarct size, rehydration may adversely exacerbate cerebral edema, causing surrounding tissues to become symptomatic. To this end, our study excluded patients with severe stroke, and the primary END mechanism in this setting may be ischemia progression or reocclusion (Alawneh et al, ). Therefore, concluding that the contribution of dehydration to END could be mediated via coagulation activation seems reasonable.…”

Section: Discussionmentioning

confidence: 99%

“…This fluid depletion reduces total plasma volume, undermines cerebral perfusion, and changes blood viscosity, potentially exacerbating the degree of hypoxia and scope of the penumbra. A few observational studies reported a two-fourfold increase in the risk for clinical deterioration in dehydrated patients during the early stage of stroke (Bahouth, Gaddis, Hillis, & Gottesman, 2018;Bhatia, Mohanty, Tripathi, Gupta, & Mittal, 2015;Lin, Yang, et al, 2011). Further study suggested that early hydration therapy could facilitate the development of collateral perfusion (Chang et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

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Contribution of dehydration to END in acute ischemic stroke not mediated via coagulation activation

et al. 2019

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Objective Dehydration is a risk factor for early neurological deterioration (END) after ischemic stroke, yet the underlying mechanism is unclear. Outbalanced coagulation activation may contribute to ischemia progression, concurrently with dehydration‐induced blood viscosity change. We aimed to investigate whether the contribution of dehydration to END was mediated by blood coagulation activation. Methods We retrospectively evaluated consecutive patients presenting with mild or moderate stroke (National Institutes of Health Stroke Scale score ≤14) within 24 hr of onset between Jan 2016 and Dec 2017. Dehydration was defined by a serum nitrogen to creatinine ratio (BUN/Cr) of ≥15 and blood coagulation activity was assessed with thromboelastography (TEG). The correlations between BUN/Cr and TEG parameters were assessed and their relationship in the development of END was analyzed. Results Of 244 patients, 64 (26.2%) developed END within 3 days after admission. Patients with END had significantly higher BUN/Cr (19.2 ± 5.7 vs. 15.3 ± 2.9, p = 0.008), shorter R and K on TEG test (R: 3.9 ± 1.0 vs. 4.6 ± 1.1, p = 0.001; K: 1.3 ± 0.5 vs. 1.5 ± 0.4, p = 0.005). Comparison between patients with and without dehydration revealed no significant differences in TEG parameters. Multivariate regression suggested that dehydration status (OR 3.91, 95%CI 2.17–8.67, p = 0.008) and shorter R tercile on TEG (OR 3.18, 95% CI 1.23–7.90, p = 0.016) were independently associated with END; however, the odds ratio of R for END remained unchanged after adjustment for dehydration status. Conclusion Our findings suggested that the contribution of dehydration to END after ischemic stroke was mediated by blood coagulation activation.

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“…The level of hydration of the body is equally important in the process of improving and regaining health after stroke. Research suggests that stroke survivors who are dehydrated may have worse short-term functional outcomes [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Post-Stroke Rehabilitation on Body Mass Composition in Relation to Socio-Demographic and Clinical Factors

Przysada

Czenczek‐Lewandowska

Wyszyńska

et al. 2020

IJERPH

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Background and objectives: Stroke is one of the leading causes of morbidity, mortality and long-term adult disability. The aim of this study was to assess the changes in body mass composition in patients after stroke in connection with selected socio-demographic and clinical factors (sex, age, type of stroke and time from the first symptoms) following the rehabilitation process. Materials and Methods: The study group consisted of 100 post-stroke subjects who participated in a comprehensive rehabilitation program for a duration of five weeks. The measurements of body composition by a Tanita MC 780 MA analyser were performed on the day of admission to hospital, on the day of discharge (after 5 weeks) and 12 weeks after discharge from hospital. Results: It was shown that before rehabilitation (Exam I) in the study group there were significant differences in body composition relative to sex, age and time from stroke. The rates of fat mass % and visceral fat level decreased after rehabilitation (Exam II) in both males and females. Exam II, at the end hospital rehabilitation, showed lower levels of fat mass %, visceral fat level, as well as fat-free mass % and higher values of total body water % and muscle mass %. In Exam III, i.e., 12 weeks after discharge, all of the parameters retained their values. Conclusions: The study shows an association between stroke risk factors (primarily age, sex and time from the onset of the first symptoms of stroke) and body mass composition resulting from rehabilitation. The type of stroke and the effects of rehabilitation on body mass components showed no differences. Comprehensive rehabilitation had a positive effect on the body mass components.

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Pilot study of volume contracted state and hospital outcome after stroke

Abstract: Acute stroke patients in a VCS demonstrate worse short-term outcomes compared to euvolemic patients, independent of infarct size. Results suggest an opportunity to explore current hydration practices.

Cited by 12 publications

References 31 publications

Admission Dehydration Is Associated With Significantly Lower In-Hospital Mortality After Intracerebral Hemorrhage

Admission Dehydration Is Associated With Significantly Lower In-Hospital Mortality After Intracerebral Hemorrhage

Contribution of dehydration to END in acute ischemic stroke not mediated via coagulation activation

Effect of Post-Stroke Rehabilitation on Body Mass Composition in Relation to Socio-Demographic and Clinical Factors

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