Stroke outcome related to initial volume status and diuretic use

Renner, C.J.; Kasner, S.E.; Bath, P.M.; Bahouth, M.N.

Abstract

Background: We hypothesized that stroke outcome is related to multiple baseline hydration-related factors including volume contracted state (VCS) and diuretic use.

Methods: We analyzed a prospective cohort of subjects with ischemic stroke <24 hours of onset, enrolled in acute treatment trials within the Virtual International Stroke Trials Archive. A VCS was defined based on BUN-to-creatinine ratio. The primary endpoint was modified Rankin Scale (mRS) at 90 days. Primary analysis employed generalized ordinal logistic regression over the mRS range, adjusted for THRIVE score, onset-to-enrollment time, and thrombolytic usage.

Results: Of 5971 eligible stroke patients, 42% were taking diuretics at the time of hospitalization and 44% were in a VCS. Patients with VCS were older, had more vascular risk factors, were more likely taking diuretics and had more severe strokes. Diuretic use was associated with both reduced chance of achieving a good functional outcome (OR 0.57;95%CI 0.52-0.63) and increased mortality at 90 days (OR 2.30;95%CI 2.04-2.61). VCS was associated with greater mortality 90 days post-stroke (OR 1.53;95%CI 1.33-1.76). There was no evidence of effect modification among the three exposures of VCS, diuretic use, or hypokalemia in relation to outcome.

Conclusions: A VCS at the time of hospitalization was associated with more severe stroke and odds of death but not associated with worse functional outcome when accounting for relevant characteristics. Diuretic use and low serum potassium at the time of stroke onset were associated with worse outcome and may be worthy of further investigation.

Citation

Renner, C., Kasner, S., Bath, P., & Bahouth, M. (2022). Stroke outcome related to initial volume status and diuretic use. Journal of the American Heart Association, 11(24), Article e026903. https://doi.org/10.1161/jaha.122.026903

• Journal Article Type: Article
• Acceptance Date: Sep 30, 2022
• Online Publication Date: Dec 14, 2022
• Publication Date: Dec 20, 2022
• Deposit Date: Oct 3, 2022
• Publicly Available Date: Oct 3, 2022
• Journal: Journal of the American Heart Association
• Electronic ISSN: 2047-9980
• Publisher: Wiley Open Access
• Peer Reviewed: Peer Reviewed
• Volume: 11
• Issue: 24
• Article Number: e026903
• DOI: https://doi.org/10.1161/jaha.122.026903
• Keywords: Cardiology and Cardiovascular Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/12023913
• Publisher URL: https://www.ahajournals.org/doi/10.1161/JAHA.122.026903