PT  - JOURNAL ARTICLE
AU  - Bahouth, Mona N.
AU  - Gaddis, Andrew
AU  - Hillis, Argye E.
AU  - Gottesman, Rebecca F.
TI  - Pilot study of volume contracted state and hospital outcome after stroke
AID  - 10.1212/CPJ.0000000000000419
DP  - 2018 Feb 01
TA  - Neurology: Clinical Practice
PG  - 21--26
VI  - 8
IP  - 1
4099  - http://cp.neurology.org/content/8/1/21.short
4100  - http://cp.neurology.org/content/8/1/21.full
AB  - Background An increasing body of research suggests that acute stroke patients who are dehydrated may have worsened functional outcomes. We sought to explore the relationship between a volume contracted state (VCS) at the time of ischemic stroke and hospital outcomes as compared with euvolemic patients.Methods We enrolled a consecutive series of ischemic stroke patients from a single academic stroke center within 12 hours from stroke onset. VCS was defined via surrogate markers (blood urea nitrogen/creatinine ratio >15 and urine specific gravity >1.010). The primary outcome was change in NIH Stroke Scale (NIHSS) score from admission to discharge. Multivariable analyses included adjustment for demographics and infarct size.Results Over an 11-month study period, 168 patients were eligible for inclusion. Of the126 with complete laboratory and MRI data, 44% were in a VCS at the time of admission. Demographics were similar in both the VCS and euvolemic groups, as were baseline NIHSS scores (6.7 vs 7.3; p = 0.63) and infarct volumes (12 vs 16 mL; p = 0.48). However, 42% of patients in a VCS demonstrated early clinical worsening, compared with 17% of the euvolemic group (p = 0.02). A VCS remained a significant predictor of worsening NIHSS in adjusted models (odds ratio 4.34; 95% confidence interval 1.75–10.76).Conclusions Acute stroke patients in a VCS demonstrate worse short-term outcomes compared to euvolemic patients, independent of infarct size. Results suggest an opportunity to explore current hydration practices.