Haemodilution for acute ischaemic stroke

Chang, Timothy S.; Jensen, Matthew B.

doi:10.1002/14651858.cd000103.pub2

Cited by 40 publications

(25 citation statements)

References 66 publications

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“…Therapies such as haemodilution, related to low osmolarity, was adopted in patients with stroke, but the conclusion remains controversial. 27–29 Further studies are needed to investigate the interactions among serum osmolarity, osmotherapy and mortality in this subgroup.…”

Section: Discussionmentioning

confidence: 99%

Association between serum osmolarity and mortality in patients who are critically ill: a retrospective cohort study

et al. 2017

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ObjectivesThis research aims to explore the association between serum osmolarity and mortality in patients who are critically ill with specific categories of disease.DesignA retrospective cohort study.Setting and participantsData were extracted from an online database named ‘Multiparameter Intelligent Monitoring in Intensive Care II’. 16 598 patients were included.MethodsPatients were divided into six disease subgroups based on the diagnosis at admission: cardiac, cerebral, vascular, gastrointestinal, respiratory and non-respiratory. The association between maximum osmolarity (osmolaritymax) and hospital mortality in each subgroup was evaluated using osmolaritymax as a design variable (six levels).ResultsAnalysis of the 16 598 patients revealed a ‘U’-shaped relationship between osmolarity and mortality with a threshold of 300 mmoL/L. For patients with non-respiratory disease, both hypo-osmolarity and hyperosmolaritymax were associated with increased mortality, with the OR increasing from osmolaritymax level 3 (OR: 1.98, 95% CI 1.69 to 2.33, p<0.001) to level 6 (OR: 4.45, 95% CI 3.58 to 5.53, p<0.001), using level 2 (290–309 mmoL/L) as the reference group. For patients with respiratory disease, however, neither hypo-osmolarity nor hyperosmolaritymax was significantly associated with mortality (levels 1 to 5) except for extreme hyperosmolaritymax (≥340 mmoL/L, OR: 2.03, 95% CI 1.20 to 3.42, p=0.007). ORs of mortality in the other four subgroups (cardiac, cerebral, vascular, gastrointestinal) were similar, with OR progressively increasing from level 3 to 6. In all six subgroups, vasopressin use was consistently associated with increased mortality.ConclusionsHyperosmolarity is associated with increased mortality in patients who are critically ill with cardiac, cerebral, vascular and gastrointestinal admission diagnoses, with thresholds at 300 mmoL/L. For patients with respiratory disease, however, no significant association was detected.

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Section: Discussionmentioning

confidence: 99%

Association between serum osmolarity and mortality in patients who are critically ill: a retrospective cohort study

et al. 2017

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“…Although it is possible that administration of exogenous albumin or albumin-oleic acid may confer some benefits for MS similar to the preclinical results described above for other conditions, high dose albumin therapy has been tested in clinical trials for ischemic stroke but was found to have no benefit, and it even increased mortality in subjects that were > 83 years old [ 173 ]. The increased mortality in elderly individuals was suggested to be due to increased myocardial stress [ 174 ]; of note, there is evidence to suggest that MS patients have a greater risk for myocardial infarction [ 175 ].…”

Section: Reviewmentioning

confidence: 99%

Albumin and multiple sclerosis

Levine

2016

BMC Neurol

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Leakage of the blood–brain barrier (BBB) is a common pathological feature in multiple sclerosis (MS). Following a breach of the BBB, albumin, the most abundant protein in plasma, gains access to CNS tissue where it is exposed to an inflammatory milieu and tissue damage, e.g., demyelination. Once in the CNS, albumin can participate in protective mechanisms. For example, due to its high concentration and molecular properties, albumin becomes a target for oxidation and nitration reactions. Furthermore, albumin binds metals and heme thereby limiting their ability to produce reactive oxygen and reactive nitrogen species. Albumin also has the potential to worsen disease. Similar to pathogenic processes that occur during epilepsy, extravasated albumin could induce the expression of proinflammatory cytokines and affect the ability of astrocytes to maintain potassium homeostasis thereby possibly making neurons more vulnerable to glutamate exicitotoxicity, which is thought to be a pathogenic mechanism in MS. The albumin quotient, albumin in cerebrospinal fluid (CSF)/albumin in serum, is used as a measure of blood-CSF barrier dysfunction in MS, but it may be inaccurate since albumin levels in the CSF can be influenced by multiple factors including: 1) albumin becomes proteolytically cleaved during disease, 2) extravasated albumin is taken up by macrophages, microglia, and astrocytes, and 3) the location of BBB damage affects the entry of extravasated albumin into ventricular CSF. A discussion of the roles that albumin performs during MS is put forth.

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“…Cerebral blood volume augmentation by plasma expansion and haemodiluition could improve cerebral perfusion in experimental stroke models [ 46 ]. However, in acute stroke trials performed in the 1990s, plasma expansion by dextran 40 and hydroxyethyl starch showed no benefit on neurological outcome or mortality [ 47 ]. Notably, all these early clinical studies were performed in the pre-thrombolysis era and outside a meaningful therapeutic window (patients were enrolled many hours or even days after symptom onset) and cerebral collateral flow was not assessed.…”

Section: Acute Therapeutic Modulation Of Cerebral Collateral Flowmentioning

confidence: 99%

Cerebral collateral circulation in experimental ischemic stroke

Cuccione

Padovano

Versace

et al. 2016

Exp & Trans Stroke Med

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Cerebral collateral circulation is a subsidiary vascular network, which is dynamically recruited after arterial occlusion, and represents a powerful determinant of ischemic stroke outcome. Although several methods may be used for assessing cerebral collaterals in the acute phase of ischemic stroke in humans and rodents, they are generally underutilized. Experimental stroke models may play a unique role in understanding the adaptive response of cerebral collaterals during ischemia and their potential for therapeutic modulation. The systematic assessment of collateral perfusion in experimental stroke models may be used as a "stratification factor" in multiple regression analysis of neuroprotection studies, in order to control the within-group variability. Exploring the modulatory mechanisms of cerebral collaterals in stroke models may promote the translational development of therapeutic strategies for increasing collateral flow and directly compare them in term of efficacy, safety and feasibility. Collateral therapeutics may have a role in the hyperacute (even pre-hospital) phase of ischemic stroke, prior to recanalization therapies.

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Haemodilution for acute ischaemic stroke

Abstract: BackgroundIschaemic stroke interrupts the flow of blood to part of the brain. Haemodilution is thought to improve the flow of blood to the affected areas of the brain and thus reduce infarct size. ObjectivesTo assess the effects of haemodilution in acute ischaemic stroke.

Cited by 40 publications

References 66 publications

Association between serum osmolarity and mortality in patients who are critically ill: a retrospective cohort study

Association between serum osmolarity and mortality in patients who are critically ill: a retrospective cohort study

Albumin and multiple sclerosis

Cerebral collateral circulation in experimental ischemic stroke

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