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

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• 作者：Chung Jen Lin ; MD^a ; ^{cyprus90210@gmail.com} ; Jen Tsung Yang ; PhD^b ; ^{jents716@ms32.hinet.net} ; Yen Chu Huang ; MD^c ; ^d ; ^{deepblue@cgmh.org.tw} ; Yuan Hsiung Tsai ; MD^d ; ^e ; ^{russell@cgmh.org.tw} ; Ming Hsueh Lee ; MD^b ; ^d ; ^{ma2072@gmail.com} ; Meng Lee ; MD^c ; ^d ; ^{menglee5126@gmail.com} ; Cheng Ting Hsiao ; MD^a ; ^d ; ^{qcth3160@cgmh.org.tw} ; Kuang Yu Hsiao ; MD^a ; ^d ; ^{richard_smith@mail2000.com.tw} ; Leng Chieh Lin ; MD^a ; ^d ; ^{a3456711@ms65.hinet.net}
• 刊名：The American Journal of Emergency Medicine
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：34
• 期：12
• 页码：2414-2418
• 全文大小：271 K
• 卷排序：34

文摘

Dehydration is associated with acute ischemic stroke. However, the relationship between hydration therapy given during acute ischemic stroke and clinical outcomes remains unclear.AimsWe determined whether hydration therapy in patients with a blood urea nitrogen/creatinine (BUN/Cr) ratio of at least 15 improved clinical outcome.MethodsWe 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.ResultsA 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.ConclusionsBlood 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.