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Neurocritical Care

, Volume 30, Issue 2, pp 478–483 | Cite as

Dehydration Status Predicts Short-Term and Long-Term Outcomes in Patients with Cerebral Venous Thrombosis

  • Kai Liu
  • Lulu Pei
  • Yuan Gao
  • Lu Zhao
  • Hui Fang
  • Bridget Bunda
  • Lindsay Fisher
  • Yunchao Wang
  • Shen Li
  • Yusheng Li
  • Sheng Guan
  • Xinbin Guo
  • Haowen Xu
  • Yuming XuEmail author
  • Bo SongEmail author
Original Article
  • 120 Downloads

Abstract

Background

Dehydration is associated with a higher risk of poor outcome and venous thromboembolism in acute ischemic stroke patients. However, the relationship between dehydration and prognosis in patients with cerebral venous thrombosis (CVT) has not yet been investigated.

Methods

Consecutive CVT patients at the First Affiliated Hospital of Zhengzhou University were retrospectively identified from November 2011 through January 2017. Dehydration was evaluated by blood urea/creatinine (U/Cr) ratio > 80. Poor functional outcome was defined as modified Rankin Scale (mRS) of 3–6. Factors such as age, sex, coma, intracerebral hemorrhage, and straight sinus and/or deep CVT involved were adjusted to assess the relationship between dehydration, and prognosis at discharge and long-term follow-up in CVT patients.

Results

A total of 220 CVT patients were included, and 85 patients (38.64%) were dehydrated. Multivariate logistic regression analysis indicated that patients with dehydration had a higher risk of mRS of 3–6 at discharge (adjusted odds ratio [OR] 3.629, 95% confidence intervals [CI] 1.526–8.633, P = 0.004) and long-term outcome (adjusted OR 3.831, 95% CI 1.597–9.190, P = 0.003). Subgroup analysis stratified by potential factors that might be associated with dehydration, such as infection, vomiting, pregnancy, and/or postpartum, showed similar results. Multivariate Cox regression analysis further demonstrated that dehydration was associated with higher mortality (adjusted hazard ratio [HR] = 2.301, 95% CI 1.025–5.166, P = 0.043).

Conclusions

The present findings indicate that dehydration is an independent predictor for short-term and long-term unfavorable functional outcome in patients with CVT.

Keywords

Cerebral venous thrombosis Dehydration Blood urea/creatinine ratio Prognosis Mortality Risk factors 

Notes

Acknowledgments

The authors thank Dechen Liu for statistical help.

Author Contribution

Project development: Dr. Bo Song and Dr. Yuming Xu; Writing (original draft preparation): Dr. Kai Liu and Dr. Lulu Pei; Data analysis: Dr. Yuan Gao, Dr. Lu Zhao, Dr. Hui Fang, and Dr. Yusheng Li; English editing help: Dr.Bridget Bunda and Lindsay Fisher; Data collection: Dr. Yunchao Wang and Shen Li; Figures and tables: Dr. Sheng Guan, Dr. Xinbin Guo, and Dr. Haowen Xu.

Source of Support

The work was supported by the Grants from the Science and Technology Department of the Henan Province (No. 152102310058 to Dr. Bo Song), the National Natural Science Foundation of China Grants (Nos. 81530037 and 81471158 to Dr. Yuming Xu; No. 81571158 to Dr. Bo Song), and China Scholarship Council (to Dr. Kai Liu).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was approved by the ethics committee of the First Ailiated Hospital of Zhengzhou University.

Supplementary material

12028_2018_628_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 15 kb)

References

  1. 1.
    Akimoto T, Ito C, Kato M, Ogura M, Muto S, Kusano E. Reduced hydration status characterized by disproportionate elevation of blood urea nitrogen to serum creatinine among the patients with cerebral infarction. Med Hypotheses. 2011;77(4):601–4.CrossRefPubMedGoogle Scholar
  2. 2.
    Chang SW, Huang YC, Lin LC, et al. Effect of dehydration on the development of collaterals in acute middle cerebral artery occlusion. Eur J Neurol. 2016;23(3):494–500.CrossRefPubMedGoogle Scholar
  3. 3.
    Bahouth MN, Gottesman RF, Szanton SL. Primary ‘dehydration’ and acute stroke: a systematic research review. J Neurol. 2018.  https://doi.org/10.1007/s00415-018-8799-6.
  4. 4.
    Kim H, Lee K, Choi HA, Samuel S, Park JH, Jo KW. Elevated blood urea nitrogen/creatinine ratio is associated with venous thromboembolism in patients with acute ischemic stroke. J Korean Neurosurg Soc. 2017;60(6):620–6.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Li SS, Yin MM, Zhou ZH, Chen HS. Dehydration is a strong predictor of long-term prognosis of thrombolysed patients with acute ischemic stroke. Brain Behav. 2017;7(11):e00849.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Schrock JW, Glasenapp M, Drogell K. Elevated blood urea nitrogen/creatinine ratio is associated with poor outcome in patients with ischemic stroke. Clin Neurol Neurosurg. 2012;114(7):881–4.CrossRefPubMedGoogle Scholar
  7. 7.
    Liu CH, Lin SC, Lin JR, et al. Dehydration is an independent predictor of discharge outcome and admission cost in acute ischaemic stroke. Eur J Neurol. 2014;21(9):1184–91.CrossRefPubMedGoogle Scholar
  8. 8.
    Rowat A, Graham C, Dennis M. Dehydration in hospital-admitted stroke patients: detection, frequency, and association. Stroke. 2012;43(3):857–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Bhalla A, Sankaralingam S, Dundas R, Swaminathan R, Wolfe CD, Rudd AG. Influence of raised plasma osmolality on clinical outcome after acute stroke. Stroke. 2000;31(9):2043–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Capecchi M, Abbattista M, Martinelli I. Cerebral venous sinus thrombosis. J Thromb Haemost. 2018.  https://doi.org/10.1111/jth.14210.
  11. 11.
    Ferro JM, Canhao P. Cerebral venous sinus thrombosis: update on diagnosis and management. Curr Cardiol Rep. 2014;16(9):523.CrossRefPubMedGoogle Scholar
  12. 12.
    Sanchez-Martin B, Grasa JM, Latorre A, et al. Acquired and inherited hypercoagulability among patients with cerebral venous thrombosis. Neurologia. 2002;17(8):405–9.PubMedGoogle Scholar
  13. 13.
    Yokus O, Sahin Balcik O, Albayrak M, et al. Evaluation of risk factors for thrombophilia in patients with cerebral venous thrombosis. Turk J Haematol. 2010;27(3):162–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Ferro JM, Canhao P, Stam J, Bousser MG, Barinagarrementeria F. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004;35(3):664–70.CrossRefPubMedGoogle Scholar
  15. 15.
    Salottolo K, Wagner J, Frei DF, et al. Epidemiology, endovascular treatment, and prognosis of cerebral venous thrombosis: US center study of 152 patients. J Am Heart Assoc. 2017;6(6):e005480.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Dentali F, Poli D, Scoditti U, et al. Long-term outcomes of patients with cerebral vein thrombosis: a multicenter study. J Thromb Haemost. 2012;10(7):1297–302.CrossRefPubMedGoogle Scholar
  17. 17.
    Wasay M, Bakshi R, Bobustuc G, et al. Cerebral venous thrombosis: analysis of a multicenter cohort from the United States. J Stroke Cerebrovasc Dis. 2008;17(2):49–54.CrossRefPubMedGoogle Scholar
  18. 18.
    Duman T, Uluduz D, Midi I, et al. A multicenter study of 1144 patients with cerebral venous thrombosis: the VENOST study. J Stroke Cerebrovasc Dis. 2017;26(8):1848–57.CrossRefPubMedGoogle Scholar
  19. 19.
    Kelly J, Hunt BJ, Lewis RR, et al. Dehydration and venous thromboembolism after acute stroke. QJM. 2004;97(5):293–6.CrossRefPubMedGoogle Scholar
  20. 20.
    O’Neill PA, Davies I, Fullerton KJ, Bennett D. Fluid balance in elderly patients following acute stroke. Age Ageing. 1992;21(4):280–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Lee TH, Chang CH, Chang YJ, Chang KC, Chung J. Establishment of electronic chart-based stroke registry system in a medical system in Taiwan. J Formos Med Assoc. 2011;110(8):543–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Liu K, Song B, Gao Y, Zhao L, Fang H, Wang Y, et al. Long-term outcomes in patients with anemia and cerebral venous thrombosis. Neurocrit Care. 2018.  https://doi.org/10.1007/s12028-018-0544-6 Google Scholar
  23. 23.
    Walmsley RN, White GH. A guide to diagnostic clinical chemistry. 3rd ed. Oxford: Blackwell Sci; 1944. p. 157–8.Google Scholar
  24. 24.
    Frey MA, Lathers C, Davis J, Fortney S, Charles JB. Cardiovascular responses to standing: effect of hydration. J Clin Pharmacol. 1994;34(5):387–93.CrossRefPubMedGoogle Scholar
  25. 25.
    Gonzalez-Alonso J, Calbet JA, Nielsen B. Muscle blood flow is reduced with dehydration during prolonged exercise in humans. J Physiol. 1998;513(Pt 3):895–905.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Ott EO, Lechner H, Aranibar A. High blood viscosity syndrome in cerebral infarction. Stroke. 1974;5(3):330–3.CrossRefPubMedGoogle Scholar
  27. 27.
    Bahouth MN, Bahrainwala Z, Hillis AE, Gottesman RF. Dehydration status is associated with more severe hemispatial neglect after stroke. Neurologist. 2016;21(6):101–5.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Visvanathan A, Dennis M, Whiteley W. Parenteral fluid regimens for improving functional outcome in people with acute stroke. Cochrane Database Syst Rev. 2015;9:Cd011138.Google Scholar
  29. 29.
    Chang TS, Jensen MB. Haemodilution for acute ischaemic stroke. Cochrane Database Syst Rev. 2014;8:Cd000103.PubMedCentralGoogle Scholar
  30. 30.
    Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46–110.CrossRefPubMedGoogle Scholar
  31. 31.
    Lin LC, Lee JD, Hung YC, Chang CH, Yang JT. Bun/creatinine ratio-based hydration for preventing stroke-in-evolution after acute ischemic stroke. Am J Emerg Med. 2014;32(7):709–12.CrossRefPubMedGoogle Scholar
  32. 32.
    Lin WC, Shih HM, Lin LC. Preliminary prospective study to assess the effect of early blood urea nitrogen/creatinine ratio-based hydration therapy on poststroke infection rate and length of stay in acute ischemic stroke. J Stroke Cerebrovasc Dis. 2015;24(12):2720–7.CrossRefPubMedGoogle Scholar
  33. 33.
    Mucke S, Grotemeyer KH, Stahlhut L, Husstedt IW, Evers S. The influence of fluid intake on stroke recurrence—a prospective study. J Neurol Sci. 2012;315(1–2):82–5.CrossRefPubMedGoogle Scholar
  34. 34.
    Lin CJ, Yang JT, Huang YC, et al. Favorable outcome of blood urea nitrogen/creatinine-based hydration therapy 3 months after acute ischemic stroke. Am J Emerg Med. 2016;34(12):2414–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2018

Authors and Affiliations

  • Kai Liu
    • 1
  • Lulu Pei
    • 1
  • Yuan Gao
    • 1
  • Lu Zhao
    • 1
  • Hui Fang
    • 1
  • Bridget Bunda
    • 2
  • Lindsay Fisher
    • 2
  • Yunchao Wang
    • 1
  • Shen Li
    • 1
  • Yusheng Li
    • 1
  • Sheng Guan
    • 3
  • Xinbin Guo
    • 3
  • Haowen Xu
    • 3
  • Yuming Xu
    • 1
    Email author
  • Bo Song
    • 1
    Email author
  1. 1.Department of NeurologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
  2. 2.Cardio-Neurology Clinic and Clinical Proteomics Research Center and Neuroprotection Research LaboratoryMassachusetts General HospitalBostonUSA
  3. 3.Department of Interventional NeurologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina

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