ISC.15: Just add water? Hydration may help turn tide in stroke care

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Could something as simple as water create a sea change in stroke care? A study unveiled Feb. 12 pointed to dehydration as a factor in poor stroke outcomes, making rehydration a possible pathway for improvement, the lead researcher told Cardiovascular Business.  

“The guidelines are shifting but still fairly general and they don’t really address how we should rehydrate a [stroke] patient,” said Mona Bahouth, MD, a neurologist at Johns Hopkins Hospital in Baltimore and the study’s presenter at the American Stroke Association’s 2015 International Stroke Conference (ISC) in Nashville, Tenn. “Physiologically speaking, it made sense to me that if a person were dehydrated we need to correct that.”

She and her colleagues conducted their study to assess dehydration in stroke patients and their outcomes. The study enrolled 168 patients admitted at their stroke center, using BUN/creatinine ratio and urine specific gravity data to gauge dehydration and diffusion-weighted MR imaging to measure lesion volume. Within that group, 75 percent had MR data and complete lab test results.

They determined that 44 percent of the patients were dehydrated at their admission. The hydrated and dehydrated groups has similar baseline National Institutes of Health Stroke Scale (NIHSS) scores and lesion volumes. For short-term outcomes, 44 percent of the dehydrated patient group had no changes or worse NIHSS scores compared with 17 percent of the hydrated patient group. By day four, the dehydrated group had a four times increased odds of an unchanged or worse clinical condition.

They are continuing to look at the data for longer-term outcomes, Bahouth said, and if those results hold up they plan to evaluate interventions through a prospective trial.

“I think early hydration is the key,” she said, but that hypothesis needs to be tested. At present neurologists lack definitive data, which may lead to variable treatment. “If it proves positive that rehydrating a patient is helpful to them, then it would be a really cheap and universally available intervention for patients.”