Predictors of early neurological deterioration in patients with acute ischaemic stroke with special reference to blood urea nitrogen (BUN)/creatinine ratio &amp; urine specific gravity

Bhatia, Kunal; Mohanty, Smita; Tripathi, Byomesh; Gupta, B. B. P.; Mittal, Manoj

doi:10.4103/0971-5916.156564

Cited by 34 publications

(21 citation statements)

References 24 publications

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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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“…The eligible patients were divided into 2 groups based on hydration status, as assessed by the BUN/Cr ratio. This ratio has been used as an indicator of dehydration in previous studies by our group and by others [17, 18, 20–26, 35–37]. Dehydrated patients had a BUN/Cr ratio ≥ 15 and those patients with a BUN/Cr ratio < 15 were placed in the non-dehydrated group.…”

Section: Methodsmentioning

confidence: 99%

“…A normal BUN/Creatinine ratio ranges from 10 to 15 [38, 39]; therefore, we defined dehydration as a BUN/Creatinine ratio ≥ 15. This ratio was preferred by other groups for the same reason [18, 36, 37]. The samples used to determine the Bun/Creatinine ratio were collected at the time of admission; therefore, dehydration status was assessed within 3 h of stroke onset.…”

Section: Methodsmentioning

confidence: 99%

The influence of dehydration on the prognosis of acute ischemic stroke for patients treated with tissue plasminogen activator

Hung

Tsai

et al. 2017

BMC Cardiovasc Disord

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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.

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“…Ischemic stroke is frequently associated with renal dysfunction and nearly a third of patients hospitalized with intracerebral haemorrhage (ICH) have chronic kidney disease (CKD) (estimated glomerular filtration rate [e-GFR] <60ml/minute per 1.73m2). 6,7 Occurrence of acute renal failure (ARF) is more common 6 Sardana and Jain / IP Indian Journal of Neurosciences 2021;7(1): [5][6][7][8][9][10] in patients with intracerebral haemorrhage (ICH) compared with those with other stroke subtypes. 8 Impaired renal function is a significant predictor of both short and long term mortality in these patients 9 Patients with stroke are often at increased risk of dehydration as they have a reduced level of consciousness, are physically dependent, unable to communicate, have difficulties in swallowing and decreased oral intake.…”

Section: Introductionmentioning

confidence: 99%

Assessment and Prognostic significance of renal dysfunction in acute stroke patients

Sardana¹,

Jain²

2021

IJN

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During hospitalization due to stroke, patients can have acute kidney injury (AKI) as a possible complication which is frequently overlooked and underestimated in clinical trials. Aims: To assess the prevalence of renal dysfunction in acute stroke patients and to assess its prognostic significance Design, Methods and Materials: A total of 100 patients were recruited for this study with diagnosis of stroke. Renal dysfunction was evaluated in the form of Acute kidney injury and unrecognized renal dysfunction (Baseline Normal serum Creatnine<1.2 mg/dl with EGFR< 60 ml/min on admission). The primary functional outcome was measured using the modified Rankin Scale at the time of discharge, 1 month after stroke onset. Statistical analysis: Analysis of data was done using SPSS-17.Independent t-test and chi-square test were used to calculate difference between two groups Results: Our study shows prevalence of acute kidney injury in patients of stroke is 15%. Moreover, the study showed that AKI after stroke was associated with higher in-hospital mortality and poorer functional outcome at 1 month. Conclusions: Acute kidney injury appears to be a common complication after stroke and is related to increased mortality and disability in stroke. Key Messages: AKI is common complication after stroke and frequent cause of poor functional outcome.

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Predictors of early neurological deterioration in patients with acute ischaemic stroke with special reference to blood urea nitrogen (BUN)/creatinine ratio & urine specific gravity

Cited by 34 publications

References 24 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

The influence of dehydration on the prognosis of acute ischemic stroke for patients treated with tissue plasminogen activator

Assessment and Prognostic significance of renal dysfunction in acute stroke patients

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