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Stroke outcome related to initial volume status and diuretic use

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

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C.J. Renner

S.E. Kasner

Stroke Association Professor of Stroke Medicine

M.N. Bahouth


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.


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.

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
Peer Reviewed Peer Reviewed
Volume 11
Issue 24
Article Number e026903
Keywords Cardiology and Cardiovascular Medicine
Public URL
Publisher URL


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