Joseph B Miller1,2,3, Christopher Lewandowski4,5, Charles R Wira6, Andrew Taylor7, Charlotte Burmeister7, Robert Welch8. 1. Department of Emergency Medicine, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA. jmiller6@hfhs.org. 2. Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA. jmiller6@hfhs.org. 3. Wayne State University, Detroit, MI, USA. jmiller6@hfhs.org. 4. Department of Emergency Medicine, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA. 5. Wayne State University, Detroit, MI, USA. 6. Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA. 7. Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA. 8. Department of Emergency Medicine, Wayne State University, Detroit, MI, USA.
Abstract
BACKGROUND: Plasma expansion in acute ischemic stroke has potential to improve cerebral perfusion, but the long-term effects on functional outcome are mixed in prior trials. The goal of this study was to evaluate how the magnitude of plasma expansion affects neurological recovery in acute stroke. METHODS: This was a secondary analysis of data from the Albumin in Acute Stroke Part 2 trial investigating the relationship between the magnitude of overall intravenous volume infusion (crystalloid and colloid) to clinical outcome. The data were inclusive of 841 patients with a mean age of 64 years and a median National Institutes of Health Stroke Scale (NIHSS) of 11. In a multivariable-adjusted logistic regression model, this analysis tested the volume of plasma expansion over the first 48 h of hospitalization as a predictor of favorable outcome, defined as either a modified Rankin Scale score of 0 or 1 or a NIHSS score of 0 or 1 at 90 days. This model included all study patients, irrespective of albumin or isotonic saline treatment. RESULTS: Patients that received higher volumes of plasma expansion more frequently had large vessel ischemic stroke and higher NIHSS scores. The multivariable-adjusted model revealed that there was decreased odds of a favorable outcome for every 250 ml additional volume plasma expansion over the first 48 h (OR 0.91, 95 % CI, 0.88-0.94). CONCLUSIONS: The present study demonstrates an association between greater volume of plasma expansion and worse neurological recovery.
BACKGROUND: Plasma expansion in acute ischemic stroke has potential to improve cerebral perfusion, but the long-term effects on functional outcome are mixed in prior trials. The goal of this study was to evaluate how the magnitude of plasma expansion affects neurological recovery in acute stroke. METHODS: This was a secondary analysis of data from the Albumin in Acute Stroke Part 2 trial investigating the relationship between the magnitude of overall intravenous volume infusion (crystalloid and colloid) to clinical outcome. The data were inclusive of 841 patients with a mean age of 64 years and a median National Institutes of Health Stroke Scale (NIHSS) of 11. In a multivariable-adjusted logistic regression model, this analysis tested the volume of plasma expansion over the first 48 h of hospitalization as a predictor of favorable outcome, defined as either a modified Rankin Scale score of 0 or 1 or a NIHSS score of 0 or 1 at 90 days. This model included all study patients, irrespective of albumin or isotonic saline treatment. RESULTS:Patients that received higher volumes of plasma expansion more frequently had large vessel ischemic stroke and higher NIHSS scores. The multivariable-adjusted model revealed that there was decreased odds of a favorable outcome for every 250 ml additional volume plasma expansion over the first 48 h (OR 0.91, 95 % CI, 0.88-0.94). CONCLUSIONS: The present study demonstrates an association between greater volume of plasma expansion and worse neurological recovery.
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