Chung Jen Lin1, Jen Tsung Yang2, Yen Chu Huang3, Yuan Hsiung Tsai4, Ming Hsueh Lee5, Meng Lee6, Cheng Ting Hsiao7, Kuang Yu Hsiao8, Leng Chieh Lin9. 1. Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan. Electronic address: cyprus90210@gmail.com. 2. Division of Neurosurgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Puzih City, Chiayi County, Taiwan. Electronic address: jents716@ms32.hinet.net. 3. Department of Neurology, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan; Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan. Electronic address: deepblue@cgmh.org.tw. 4. Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan; Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan. Electronic address: russell@cgmh.org.tw. 5. Division of Neurosurgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Puzih City, Chiayi County, Taiwan; Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan. Electronic address: ma2072@gmail.com. 6. Department of Neurology, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan; Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan. Electronic address: menglee5126@gmail.com. 7. Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan; Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan. Electronic address: qcth3160@cgmh.org.tw. 8. Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan; Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan. Electronic address: richard_smith@mail2000.com.tw. 9. Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan; Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan. Electronic address: a3456711@ms65.hinet.net.
Abstract
BACKGROUND: Dehydration is associated with acute ischemic stroke. However, the relationship between hydration therapy given during acute ischemic stroke and clinical outcomes remains unclear. AIMS: We determined whether hydration therapy in patients with a blood urea nitrogen/creatinine (BUN/Cr) ratio of at least 15 improved clinical outcome. METHODS: We conducted a nonblinded, phase II, single-arm, prospective study of patients with acute ischemic stroke and BUN/Cr ratio of at least 15 with historical controls. The hydration group received intravenous bolus (300-500 mL) saline followed by maintenance saline infusion (40-80 mL/h for the first 72 hours), whereas the control group received maintenance saline infusion (40-60 mL/h for the first 24 hours and 0-60 mL/h for 24-72 hours after stroke). The study end point was the percentage of patients with a favorable outcome defined as modified Rankin scale score of 2 or lower at 3 months after stroke. RESULTS: A total of 237 patients were enrolled (hydration, n = 134; control, n = 103). The mean volume of saline infused within the first 72 hours was significantly larger (P < .001), and the rate of favorable outcome at 3 months after stroke was significantly higher (P = .016) in the hydration group than in the controls. Further analysis revealed that the difference was significant in the lacunar stroke subtype (P = .020) but not in the nonlacunar subtype. CONCLUSIONS: Blood urea nitrogen/Cr ratio-based saline hydration therapy in patients with acute ischemic stroke significantly increased the rate of favorable clinical outcome with functional independence at 3 months after stroke.
BACKGROUND: Dehydration is associated with acute ischemic stroke. However, the relationship between hydration therapy given during acute ischemic stroke and clinical outcomes remains unclear. AIMS: We determined whether hydration therapy in patients with a blood ureanitrogen/creatinine (BUN/Cr) ratio of at least 15 improved clinical outcome. METHODS: We conducted a nonblinded, phase II, single-arm, prospective study of patients with acute ischemic stroke and BUN/Cr ratio of at least 15 with historical controls. The hydration group received intravenous bolus (300-500 mL) saline followed by maintenance saline infusion (40-80 mL/h for the first 72 hours), whereas the control group received maintenance saline infusion (40-60 mL/h for the first 24 hours and 0-60 mL/h for 24-72 hours after stroke). The study end point was the percentage of patients with a favorable outcome defined as modified Rankin scale score of 2 or lower at 3 months after stroke. RESULTS: A total of 237 patients were enrolled (hydration, n = 134; control, n = 103). The mean volume of saline infused within the first 72 hours was significantly larger (P < .001), and the rate of favorable outcome at 3 months after stroke was significantly higher (P = .016) in the hydration group than in the controls. Further analysis revealed that the difference was significant in the lacunar stroke subtype (P = .020) but not in the nonlacunar subtype. CONCLUSIONS: Blood ureanitrogen/Cr ratio-based saline hydration therapy in patients with acute ischemic stroke significantly increased the rate of favorable clinical outcome with functional independence at 3 months after stroke.