Favorable outcome of blood urea nitrogen/creatinine–based hydration therapy 3 months after acute ischemic stroke

Lin, Chung Jen; Yang, Jing‐Tang; Huang, Yen Chu; Tsai, Yuan-Hsiung; Lee, Ming Hsueh; Lee, Meng; Hsiao, Cheng Ting; Hsiao, Kuang Yu; Lin, Liyan

doi:10.1016/j.ajem.2016.09.033

Cited by 30 publications

(21 citation statements)

References 33 publications

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“…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, ). However, the confounding effect regarding distinct END mechanisms in mild or severe stroke was seldom considered in those studies.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…13- 16 Moreover, higher BUN/Cr was found to be associated with poor outcome in AIS patients. 17, 18 The relationship between BUN and in-hospital mortality and short-term outcomes in AIS patients, however, is unclear. Moreover, the prognostic value of BUN in comparison with other CKD biomarkers is also unknown.…”

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confidence: 99%

Prognostic Significance of Blood Urea Nitrogen in Acute Ischemic Stroke

You

Zheng

Zhong

et al. 2018

Circ J

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Background:Prior studies have shown an association between high blood urea nitrogen (BUN) and an elevated risk of mortality in heart failure patients, but data on the prognostic significance of BUN and other markers of kidney function in acute ischemic stroke (AIS) patients are sparse. Methods and Results:A total of 3,355 AIS patients were enrolled from December 2013 to May 2014, across 22 hospitals. Admission BUN was divided into quartiles (Q1, <4.39 mmol/L; Q2, ≥4.39 and <5.40 mmol/L; Q3, ≥5.40 and <6.70 mmol/L and Q4, ≥6.70 mmol/L) and estimated glomerular filtration rate (eGFR), creatinine (Cr) and BUN/Cr were also categorized. Cox proportional hazard and logistic regression models were used to estimate the effect of BUN, eGFR, Cr and BUN/Cr on all-cause in-hospital mortality and poor outcome on discharge (modified Rankin Scale score ≥3) in AIS patients. During hospitalization, 120 patients (3.6%) died from all causes and 1,287 (38.4%) had poor outcome at discharge. BUN was independently associated with all-cause in-hospital mortality (adjusted HR for Q4 vs. Q1, 3.75; 95% CI: 1.53-9.21; P-trend=0.003) but not poor outcome at discharge (P-trend=0.229). No significant association was found, however, between reduced eGFR, increased Cr and BUN/Cr and all-cause in-hospital mortality and poor outcome at discharge (all P-trend ≥0.169). Conclusions:Increased BUN at admission is a significant prognostic factor associated with in-hospital mortality in AIS patients, but not with poor discharge outcome.

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“…This is probably caused by small number of subjects in this study and there was unbalanced number of the subject between hyperviscosity and nonhyperviscosity group. Another limitation of this study is that outcome of patients on day 90 post-thrombolysis could not be evaluated even though it is the standard measurement of acute ischemic stroke patients' functional outcome [51].…”

Section: Discussionmentioning

confidence: 99%

Blood Viscosity as a Determining Factor of Ischemic Stroke Outcomes Evaluated With Nihss and MRS on Day 7 and 30 Post-Thrombolysis

Rasyid

Harris

Kurniawan

et al. 2019

Int J Pharm Pharm Sci

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Objective: This study aimed to analyze blood viscosity as a determining factor of ischemic stroke outcomes evaluated with National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) on day 7 and 30 post-thrombolysis. Methods:This study was a 4-months cohort study taking place in Cipto Mangunkusumo General Hospital from January to April 2017. Subjects were collected at the Emergency Department or Neurology Outpatient Department. Eligible patients gave informed consent. Patients underwent numerous examinations, including blood viscosity test using digital microcapillary (DM) instrument. Outcomes of patients were identified on day 7 and day 30 post-thrombolysis using NIHSS and mRS, respectively. Results:Most acute ischemic stroke patients (88.6%) had blood hyperviscosity. 9.1% patients had poorer neurologic deficit on day 7 evaluated with NIHSS and 18.2% patients had poor outcome on day 30 evaluated with mRS. All patients with normal blood viscosity did not have a poorer neurologic deficit on day-7-evaluation.Conclusion: Blood viscosity determines the outcomes of acute ischemic stroke patients on day 7 and day 30 post-thrombolysis.

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Favorable outcome of blood urea nitrogen/creatinine–based hydration therapy 3 months after acute ischemic stroke

Cited by 30 publications

References 33 publications

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

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

Prognostic Significance of Blood Urea Nitrogen in Acute Ischemic Stroke

Blood Viscosity as a Determining Factor of Ischemic Stroke Outcomes Evaluated With Nihss and MRS on Day 7 and 30 Post-Thrombolysis

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