Urine specific gravity as a predictor of early neurological deterioration in acute ischemic stroke

Lin, Li-Mei; Fann, Wen-Chih; Chou, Man-Chun; Chen, H.W.; Su, Yu‐Jih; Chen, J.C.

doi:10.1016/j.mehy.2011.03.012

Cited by 35 publications

(48 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A correlation between BUN/Cr ratio ≥15 and worse outcome was also found in stroke patients (Schrock et al., 2012). USG was also reported to be useful as a predictor of early deterioration in patients with acute ischemic stroke (Lin et al., 2011). In the present study, we found that the mRS 3–6 was associated with a higher BUN/Cr, USG, and dehydration status, compared to the mRS 0–2.…”

Section: Discussionmentioning

confidence: 99%

“…However, multivariate logistic regression analysis showed that BUN/Cr ratio ≥15 combined with USG > 1.010, but not either of them was independently associated with the poor outcome. The results are different from the previous results that BUN/Cr ratio ≥15 or USG > 1.010 was an independent risk of early neurological deterioration in patients with acute ischemic stroke (Aronson et al., 2008; Lin et al., 2011, 2011; Vullo‐Navich et al., 1998; Weinberg et al., 1994). The reason may be: (1) the effect of dehydration on long‐term prognosis was determined in the present study, while the effect on short‐term prognosis in other studies; (2) thrombolysed patients with acute cerebral infarction are subjects in the present study, who are different from patients with acute cerebral infarction in other studies; (3) BUN/Cr ≥ 15 combined with USG > 1.010 was used as a marker of dehydration status in our study, while either of them as a marker in other studies; (4) mRS 0–2 was used as a good outcome in the present study, while mRS ≤ 1 was defined as a good outcome in other studies (Cappellari et al., 2013; Song et al., 2017; Tsivgoulis et al., 2016).…”

Section: Discussionmentioning

confidence: 99%

“…As discussed above, BUN/Cr ≥ 15 or USG > 1.010 was often used as a maker of dehydration status in previous studies (Akimoto et al., 2011; Bhatia et al., 2015; Lin et al., 2011; Schrock et al., 2012). USG > 1.030 has also been reported as a marker in only one study with subjects in an ultralow‐humidity environment (Su et al., 2006).…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have shown that BUN/Cr ratio as a marker of dehydration status was an independent predictor of early neurological deterioration (END) and poor outcomes 30 days post stroke among patients who had suffered acute ischemic stroke (Aronson et al., 2008; Lin et al., 2011; Vullo‐Navich et al., 1998; Weinberg et al., 1994). Some findings suggest that USG as a marker of dehydration status may be associated with stroke in evolution in patients with acute ischemic stroke (Lin et al., 2011; Schrock et al., 2012). In these studies (Akimoto et al., 2011; Bhatia et al., 2015; Lin et al., 2011; Schrock et al., 2012), BUN/Cr ≥ 15 or USG > 1.010 was often used as a maker of dehydration status, but the conclusion about the role of dehydration status in ischemic stroke was controversial.…”

Section: Introductionmentioning

confidence: 99%

“…Some findings suggest that USG as a marker of dehydration status may be associated with stroke in evolution in patients with acute ischemic stroke (Lin et al., 2011; Schrock et al., 2012). In these studies (Akimoto et al., 2011; Bhatia et al., 2015; Lin et al., 2011; Schrock et al., 2012), BUN/Cr ≥ 15 or USG > 1.010 was often used as a maker of dehydration status, but the conclusion about the role of dehydration status in ischemic stroke was controversial. USG > 1.030 has also been reported as a marker in only one study with subjects in an ultralow‐humidity environment (Su et al., 2006).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Dehydration is a strong predictor of long‐term prognosis of thrombolysed patients with acute ischemic stroke

Yin

Zhou

et al. 2017

Brain and Behavior

View full text Add to dashboard Cite

Background and PurposeDehydration was found to be involved in the poor prognosis of patients with acute ischemic stroke. It is unclear whether dehydration status before onset is related with prognosis of thrombolysed patients with acute ischemic stroke. If it is the case, quickly hydrating may improve the prognosis. The present study was designed to explore the issue.MethodsEligible 294 patients with acute ischemic stroke after thrombolysis were enrolled in the present study according to inclusion/exclusion criteria. According to the modified Rankin scale (mRS) 90 days post stroke, the patients were divided into two groups: mRS 0–2 (n = 191) and mRS 3–6 (n = 103). In the present study, BUN/Cr ≥ 15 combined with USG > 1.010 or either of them were chosen as dehydration marker. Clinical data were analyzed between two groups. Univariate and multivariate statistical analyses were carried out.ResultsAge, fibrinogen, blood glucose, BUN/Cr, NIHSS score at admission, the systolic blood pressure (SBP) before thrombolysis, dehydration status (BUN/Cr ≥ 15 plus USG > 1.010), hyperlipidemia, USG and D‐dimer on admission day, and TOAST classification showed significant difference between two groups (p < .05). Further stratification analysis showed that BUN/Cr ≥ 15, NIHSS ≥ 6, blood glucose ≥8, and SBP > 150 were markedly associated with poor outcome (mRS 3–6, p < .05). After adjusting for age, fibrinogen, USG, D‐dimer, dehydration status, NIHSS, blood glucose, SBP, hyperlipidemia, and BUN/Cr at admission, multivariate logistic regression showed that dehydration status, higher NIHSS, higher blood glucose, and higher SBP at admission were independent risk factors for predicting the long‐term poor prognosis of thrombolysed patients.ConclusionsThe present findings suggest that BUN/Cr ≥ 15 combined with USG > 1.010 as a marker of dehydration status was an independent risk factor for long‐term poor prognosis of thrombolysed patients with acute ischemic stroke.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Dehydration is a strong predictor of long‐term prognosis of thrombolysed patients with acute ischemic stroke

Yin

Zhou

et al. 2017

Brain and Behavior

View full text Add to dashboard Cite

show abstract

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

et al. 2019

View full text Add to dashboard Cite

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.

show abstract

Differentiation of epilepsy and psychogenic nonepileptic events based on body fluid characteristics

Xia

Lai

et al. 2023

Epilepsia Open

View full text Add to dashboard Cite

ObjectiveDifferential diagnosis between epileptic seizures and psychogenic nonepileptic events (PNEEs) is a worldwide problem for neurologists. The present study aims to identify important characteristics from body fluid tests and develop diagnostic models based on them.MethodsThis is a register‐based observational study in patients with a diagnosis of epilepsy or PNEEs at West China Hospital of Sichuan University. Data from body fluid tests between 2009 and 2019 were used as a training set. We constructed models with a random forest approach in eight training subsets divided by sex and categories of tests, including electrolyte, blood cell, metabolism, and urine tests. Then, we collected data prospectively from patients between 2020 and 2022 to validate our models and calculated the relative importance of characteristics in robust models. Selected characteristics were finally analyzed with multiple logistic regression to establish nomograms.ResultsA total of 388 patients, including 218 with epilepsy and 170 with PNEEs, were studied. The AUROCs of random forest models of electrolyte and urine tests in the validation phase achieved 80.0% and 79.0%, respectively. Carbon dioxide combining power, anion gap, potassium, calcium, and chlorine in electrolyte tests and specific gravity, pH, and conductivity in urine tests were selected for the logistic regression analysis. C (ROC) of the electrolyte and urine diagnostic nomograms achieved 0.79 and 0.85, respectively.SignificanceThe application of routine indicators of serum and urine may help in the more accurate identification of epileptic and PNEEs.

show abstract

Urine specific gravity as a predictor of early neurological deterioration in acute ischemic stroke

Cited by 35 publications

References 17 publications

Dehydration is a strong predictor of long‐term prognosis of thrombolysed patients with acute ischemic stroke

Dehydration is a strong predictor of long‐term prognosis of thrombolysed patients with acute ischemic stroke

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

Differentiation of epilepsy and psychogenic nonepileptic events based on body fluid characteristics

Contact Info

Product

Resources

About