Volume contracted state, mortality and functional outcomes in patients with acute ischaemic stroke due to large vessel occlusion
Background Acute ischaemic stroke (AIS) is a leading cause of mortality and disability globally, with volume contracted state (VCS), as indicated by an elevated blood urea nitrogen to creatinine (BUN/Cr) ratio, potentially influencing outcomes. This study investigates the association between VCS and...
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BMJ Publishing Group
2025-02-01
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| Series: | BMJ Neurology Open |
| Online Access: | https://neurologyopen.bmj.com/content/7/1/e000974.full |
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| author | Risheng Xu Max Wintermark Gregory W Albers Jeremy J Heit Adam A Dmytriw Adrien Guenego Yasmin Aziz Kambiz Nael Benjamin Pulli Victor Urrutia Dhairya A Lakhani Tobias D Faizy Argye Hillis Vivek Yedavalli Dylan Wolman Licia P Luna Elisabeth B Marsh Hamza Adel Salim Janet Mei Vaibhav Vagal Aakanksha Sriwastwa Raf Llinas Hanzhang Lu Mona N Bahouth |
| author_facet | Risheng Xu Max Wintermark Gregory W Albers Jeremy J Heit Adam A Dmytriw Adrien Guenego Yasmin Aziz Kambiz Nael Benjamin Pulli Victor Urrutia Dhairya A Lakhani Tobias D Faizy Argye Hillis Vivek Yedavalli Dylan Wolman Licia P Luna Elisabeth B Marsh Hamza Adel Salim Janet Mei Vaibhav Vagal Aakanksha Sriwastwa Raf Llinas Hanzhang Lu Mona N Bahouth |
| author_sort | Risheng Xu |
| collection | DOAJ |
| description | Background Acute ischaemic stroke (AIS) is a leading cause of mortality and disability globally, with volume contracted state (VCS), as indicated by an elevated blood urea nitrogen to creatinine (BUN/Cr) ratio, potentially influencing outcomes. This study investigates the association between VCS and clinical outcomes in patients with AIS due to large vessel occlusion (LVO).Methods A retrospective cohort study was conducted involving 298 patients with LVO-AIS from two comprehensive stroke centres. Patients were divided into two groups based on BUN/Cr ratio: ≤20 (n=205) and >20 (n=93). Primary outcomes included 90-day mortality and unfavourable functional outcomes, defined as a modified Rankin Scale score of 3–6. Secondary outcomes included the successful reperfusion, haemorrhagic transformation and National Institutes of Health Stroke Scale score at discharge.Results Patients with a BUN/Cr ratio >20 had significantly higher 90-day mortality (35% vs 13%, p<0.001) and this association remained significant after adjusting for confounding factors (OR 2.20; 95% CI 1.11 to 4.39; p=0.024). However, VCS was not significantly associated with unfavourable functional outcomes at 90 days (OR 1.28; 95% CI 0.67 to 2.51; p=0.46). Age and initial stroke severity were more strongly associated with long-term functional outcomes.Conclusions VCS is associated with higher odds of 90-day mortality in patients with LVO-AIS but not with unfavourable functional outcomes. These findings suggest the need for further research into the role of hydration management in improving survival in patients with AIS, potentially informing future treatment protocols. |
| format | Article |
| id | doaj-art-67f3c1f19c334c2a8fbe3bace4f19fc8 |
| institution | Kabale University |
| issn | 2632-6140 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Neurology Open |
| spelling | doaj-art-67f3c1f19c334c2a8fbe3bace4f19fc82025-02-04T16:50:10ZengBMJ Publishing GroupBMJ Neurology Open2632-61402025-02-017110.1136/bmjno-2024-000974Volume contracted state, mortality and functional outcomes in patients with acute ischaemic stroke due to large vessel occlusionRisheng Xu0Max Wintermark1Gregory W Albers2Jeremy J Heit3Adam A Dmytriw4Adrien Guenego5Yasmin Aziz6Kambiz Nael7Benjamin Pulli8Victor Urrutia9Dhairya A Lakhani10Tobias D Faizy11Argye Hillis12Vivek Yedavalli13Dylan Wolman14Licia P Luna15Elisabeth B Marsh16Hamza Adel Salim17Janet Mei18Vaibhav Vagal19Aakanksha Sriwastwa20Raf Llinas21Hanzhang Lu22Mona N Bahouth23Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USAMD Anderson Children’s Cancer Hospital, Houston, Texas, USADepartment of Neurology, Stanford University School of Medicine, Stanford, California, USADepartment of Interventional Neuroradiology, Stanford Medical Center, Stanford, California, USANeuroendovascular Program, Massachusetts General Hospital & Brigham and Women`s Hospital, Harvard University, Boston, Massachusetts, USADepartment of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, BelgiumDepartment of Neurology, University of Cincinnati Medical Center, Cincinnati, Ohio, USARadiological Sciences, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USADepartment of Radiology, Stanford University, Stanford, California, USA2 Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USAWest Virginia University, Morgantown, West Virginia, USAUniversity Medical Center Munster, Munster, GermanyDepartment of Neurology, Johns Hopkins Medical Center, Baltimore, Maryland, USAJohns Hopkins School of Medicine, Baltimore, Maryland, USA3 Radiology, Kaiser Permanente, Portland, Oregon, USADepartment of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, Maryland, USAJohns Hopkins School of Medicine, Baltimore, Maryland, USAJohns Hopkins School of Medicine, Baltimore, Maryland, USADepartment of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USAStony Brook University Renaissance School of Medicine, Stony Brook, New York, USADepartment of Neurology, University of Cincinnati Medical Center, Cincinnati, Ohio, USADepartment of Neurology, Johns Hopkins Medical Center, Baltimore, Maryland, USADepartment of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USADepartment of Neurology, Johns Hopkins Medical Center, Baltimore, Maryland, USABackground Acute ischaemic stroke (AIS) is a leading cause of mortality and disability globally, with volume contracted state (VCS), as indicated by an elevated blood urea nitrogen to creatinine (BUN/Cr) ratio, potentially influencing outcomes. This study investigates the association between VCS and clinical outcomes in patients with AIS due to large vessel occlusion (LVO).Methods A retrospective cohort study was conducted involving 298 patients with LVO-AIS from two comprehensive stroke centres. Patients were divided into two groups based on BUN/Cr ratio: ≤20 (n=205) and >20 (n=93). Primary outcomes included 90-day mortality and unfavourable functional outcomes, defined as a modified Rankin Scale score of 3–6. Secondary outcomes included the successful reperfusion, haemorrhagic transformation and National Institutes of Health Stroke Scale score at discharge.Results Patients with a BUN/Cr ratio >20 had significantly higher 90-day mortality (35% vs 13%, p<0.001) and this association remained significant after adjusting for confounding factors (OR 2.20; 95% CI 1.11 to 4.39; p=0.024). However, VCS was not significantly associated with unfavourable functional outcomes at 90 days (OR 1.28; 95% CI 0.67 to 2.51; p=0.46). Age and initial stroke severity were more strongly associated with long-term functional outcomes.Conclusions VCS is associated with higher odds of 90-day mortality in patients with LVO-AIS but not with unfavourable functional outcomes. These findings suggest the need for further research into the role of hydration management in improving survival in patients with AIS, potentially informing future treatment protocols.https://neurologyopen.bmj.com/content/7/1/e000974.full |
| spellingShingle | Risheng Xu Max Wintermark Gregory W Albers Jeremy J Heit Adam A Dmytriw Adrien Guenego Yasmin Aziz Kambiz Nael Benjamin Pulli Victor Urrutia Dhairya A Lakhani Tobias D Faizy Argye Hillis Vivek Yedavalli Dylan Wolman Licia P Luna Elisabeth B Marsh Hamza Adel Salim Janet Mei Vaibhav Vagal Aakanksha Sriwastwa Raf Llinas Hanzhang Lu Mona N Bahouth Volume contracted state, mortality and functional outcomes in patients with acute ischaemic stroke due to large vessel occlusion BMJ Neurology Open |
| title | Volume contracted state, mortality and functional outcomes in patients with acute ischaemic stroke due to large vessel occlusion |
| title_full | Volume contracted state, mortality and functional outcomes in patients with acute ischaemic stroke due to large vessel occlusion |
| title_fullStr | Volume contracted state, mortality and functional outcomes in patients with acute ischaemic stroke due to large vessel occlusion |
| title_full_unstemmed | Volume contracted state, mortality and functional outcomes in patients with acute ischaemic stroke due to large vessel occlusion |
| title_short | Volume contracted state, mortality and functional outcomes in patients with acute ischaemic stroke due to large vessel occlusion |
| title_sort | volume contracted state mortality and functional outcomes in patients with acute ischaemic stroke due to large vessel occlusion |
| url | https://neurologyopen.bmj.com/content/7/1/e000974.full |
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