Favorable outcome of blood urea nitrogen/creatinine-based hydration therapy 3 months after acute ischemic 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 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. (C) 2016 Elsevier Inc. All rights reserved.