1
|
Wang L, Zhu X, Li H, Jia B, Xie W, Zhang Y, Wang L, Liu L, Li M. Association between blood urea nitrogen to creatinine ratio and 3-month outcome in patients with acute ischaemic stroke: a retrospective cohort study from a large healthcare system. BMJ Open 2024; 14:e085912. [PMID: 39038861 DOI: 10.1136/bmjopen-2024-085912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024] Open
Abstract
OBJECTIVES The blood urea nitrogen to creatinine (BUN/Cr) ratio is associated with early neurological deterioration in acute ischaemic stroke (AIS). However, the predictive value of the BUN/Cr ratio for the AIS prognosis remains unclear. Therefore, we evaluated the correlation between the BUN/Cr ratio and the 3-month outcome in patients with AIS, further testing their dose-response relationship. DESIGN This retrospective cohort study enrolled patients with AIS who were admitted between 1 January 2013 and 31 May 2022. Poor clinical outcome was defined as 3-month Modified Rankin Scale (mRS) >2. Cox proportional HR was used to evaluate the correlation between the BUN/Cr ratio and 3-month outcome. Restricted cubic spline and robust locally weighted regression analyses were conducted to determine the dose-response relationship between the BUN/Cr ratio and the 3-month outcome. RESULTS A total of 4952 eligible patients were included in the study. The patients were divided into three groups according to the tertiles of BUN/Cr ratio (T1, <0.071; T2, 0.071-0.093; and T3, >0.093). After logistic regression adjustment for demographic and clinical characteristics, the BUN/Cr ratio was found to be independently associated with the 3-month outcome in patients with AIS. The restricted cubic spline and locally regression smoothing scatterplot graph showed a strong dose-response relationship between the BUN/Cr ratio and the 3-month outcome in patients with AIS. CONCLUSION A dose-response relationship was observed between the BUN/Cr ratio and the 3-month outcome in patients with AIS, suggesting that the BUN/Cr ratio could serve as a reliable predictor for the AIS prognosis.
Collapse
Affiliation(s)
- Liumin Wang
- Department of Neurology, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xinmei Zhu
- Department of Neurology, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Hui Li
- Taikang Community Su Garden, Nanjing, China
| | - Boluo Jia
- Nanjing Qixia District Xigang Community Health Service Center, Nanjing, China
| | - Wen Xie
- Department of Neurology, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yanli Zhang
- Department of Neurology, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Lina Wang
- Department of Neurology, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ling Liu
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Mingquan Li
- Department of Neurology, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| |
Collapse
|
2
|
Jiang F, Li J, Yu S, Miao J, Wang W, Xi X. Body fluids biomarkers associated with prognosis of acute ischemic stroke: progress and prospects. Future Sci OA 2024; 10:FSO931. [PMID: 38817358 PMCID: PMC11137785 DOI: 10.2144/fsoa-2023-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/27/2023] [Indexed: 06/01/2024] Open
Abstract
Acute ischemic stroke (AIS) is one of the most common strokes posing a grave threat to human life and health. Predicting the prognosis of AIS allows for an understanding of disease progress, and a better quality of life by making individualized treatment scheme. In this paper, we conducted a systematic search on PubMed, focusing on the relevant literature in the last 5 years. Summarizing the candidate prognostic biomarkers of AIS in body fluids such as blood, urine, saliva and cerebrospinal fluid is often of great significance for the management of acute ischemic stroke, which has the potential to facilitate early diagnosis, treatment, prevention and long-term outcome improvement.
Collapse
Affiliation(s)
- Fengmang Jiang
- Emergency Intensive Care Unit, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, PR China
| | - Junhua Li
- Emergency Intensive Care Unit, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, PR China
| | - Simin Yu
- Emergency Intensive Care Unit, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, PR China
| | - Jinli Miao
- Biological Medicine Research & Development Center, Yangtze Delta of Zhejiang, Hangzhou, 314006, PR China
| | - Wenmin Wang
- Biological Medicine Research & Development Center, Yangtze Delta of Zhejiang, Hangzhou, 314006, PR China
| | - Xiaohong Xi
- Emergency Intensive Care Unit, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, PR China
| |
Collapse
|
3
|
Ding J, Lan D, Zhang X, Li X, Duan Y, Tian X, Liao Z, Yue X, Zou M, Meng R. Dehydration in cerebral venous sinus thrombosis. CNS Neurosci Ther 2024; 30:e14760. [PMID: 38775183 PMCID: PMC11110100 DOI: 10.1111/cns.14760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/12/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
AIMS This study aimed to unravel the dehydration status of patients with cerebral venous sinus thrombosis (CVST) to facilitate the understanding of dehydration in CVST. METHODS This was a multicenter retrospective study and three populations were recruited, namely, patients with CVST, CVST mimics, and healthy subjects. Blood samples were obtained 1-2 days after admission to assess dehydration status. Stata 15.1 was performed for statistical analysis. RESULTS A total of 208 patients were diagnosed with CVST, 237 with CVST mimics, and 200 healthy individuals were enrolled. The urine specific gravity (USG, 1.020 [1.014, 1.029] vs. 1.017 [1.011, 1.021]) was higher in patients with CVST than in those with mimics (all p < 0.001). The percentage of USG >1.03 was also higher in CVST (22.6%) than in its mimics (6.3%, p < 0.001). With the development of CVST, USG (acute vs. sub-acute vs. chronic, 1.022 [1.015, 1.033] vs. 1.021 [1.015, 1.031] vs. 1.019 [1.014, 1.025]) decreased. All dehydration-related markers could not differentiate CVST from its mimics and healthy populations, and they were not associated with CVST severity and prognosis (p > 0.05). CONCLUSION High levels of USG, especially USG >1.013, were more common in patients with CVST. Dehydration-related indices could not characterize CVST and were not associated with CVST severity and prognosis.
Collapse
Affiliation(s)
- Jiayue Ding
- Department of NeurologyTianjin Medical University General HospitalTianjinChina
| | - Duo Lan
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Xiaoming Zhang
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Xiangyu Li
- Department of NeurologyTianjin Huanhu HospitalTianjinChina
| | - Yanli Duan
- Department of NeurologyTianjin Medical University General HospitalTianjinChina
| | - Xiaobing Tian
- Department of NeurologyTianjin Medical University General HospitalTianjinChina
| | - Zhangyuan Liao
- Department of NeurologyTianjin Medical University General HospitalTianjinChina
| | - Xuanye Yue
- Department of NeurologyTianjin Medical University General HospitalTianjinChina
| | - Ming Zou
- Department of NeurologyTianjin Medical University General HospitalTianjinChina
| | - Ran Meng
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| |
Collapse
|
4
|
Ali ZH, Abd-Elaziz M, Abdrbo A. Dysphagia and daily oral fluids among cerebrovascular stroke patients: an theory-based nursing intervention protocol. FRONTIERS OF NURSING 2023; 10:213-222. [DOI: 10.2478/fon-2023-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Abstract
Objective
To evaluate the improvement of dysphagia and the daily amounts of oral fluids served among people who had recently experienced a cerebrovascular stroke (CVS) after applying a nursing intervention protocol.
Methods
A quasi-experimental design was used to examine 60 stroke patients who were randomly and alternatively divided equally into a study group and a control group. Gugging Swallowing Screen (GUSS) and fluid balance chart were used. Within the first 24 h of a patient’s admission, expert nurses were trained in nursing intervention protocol to manage dysphagia and daily oral fluids.
Results
Post-nursing intervention, the severity of dysphagia decreased among the study group more than in the control group. Additionally, the study group began taking greater amounts of fluids by the oral route than before the nursing intervention.
Conclusions
A standardized nursing intervention protocol is needed to decrease the severity of dysphagia after CVS and increase the amount of daily oral fluids. The presence of a structured theory-based nursing intervention protocol for dysphagia management will greatly contribute to decreasing the consequences of dysphagia after CVS, and can also be expected to attenuate the effects of aspiration pneumonia, dehydration, and malnutrition; further, it also increases adherence to the protocol by both nurses and patients.
Collapse
Affiliation(s)
- Zeinab Hussein Ali
- a Department of Adult Health Nursing, Faculty of Nursing, Helwan University , Ain Helwan , Cairo , Egypt
| | - Marwa Abd-Elaziz
- b Department of Adult Health Nursing & Focal Point of International Relations, Faculty of Nursing, Helwan University , Ain Helwan , Cairo , Egypt
| | - Amany Abdrbo
- c Nursing Department, Almoosa College for Health Sciences , , al-Mubarraz , Saudi Arabia
| |
Collapse
|
5
|
Li H, Wang H, Fu Q, Liu Y, Song B, Zhao J, Lin J. Association of Bun/Cr ratio-based dehydration status with infarct volumes and stroke severity in acute ischemic stroke. Clin Neurol Neurosurg 2023; 229:107741. [PMID: 37119656 DOI: 10.1016/j.clineuro.2023.107741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Only a few clinical research had previously investigated the dehydration status to predict the evolution of the ischemic core. The aim of this study is to clarify the association between blood urea nitrogen (BUN)/creatinine (Cr)ratio-based dehydration and infarct volume measured using DWI (Diffusion-weighted imaging) at admission in patients with AIS (Acute Ischemic Stroke). METHODS We retrospectively recruited a total of 203 consecutive patients who were hospitalized through emergency or outpatient services within 72 h of acute ischemic stroke onset between October 2015 and September 2019. Stroke severity was measured by assessing the National Institutes of Health Stroke Scale (NIHSS) on admission. Infarct volume was measured using DWI with MATLAB software. RESULTS In this study, 203 patients who met the study criteria were enrolled. Patients in the dehydration group (Bun/Cr ratio>15) had a higher median NIHSS score (6(IQR:4-10) VS. 5(3-7); P = 0.0015)and larger DWI infarct volume (1.55 ml (IQR:0.51-6.79) VS. (0.37 ml (0.05-1.22); P < 0.001) on admission compared with patients in normal group. Further, a statistically significant correlation was found between DWI infarct volumes and NIHSS score with nonparametric Spearman rank correlation (r = 0.77; P < 0.001). The median NIHSS scores for the DWI infarct volumes quartiles were 3 ml (IQR, 2-4), 5 ml (4-7), 6 ml (5-8), and12 ml (8-17) from lowest to highest. However, the second quartile group did not show any significant correlation with the third quartile group (P = 0.4268). Multivariable linear and logistic regression analyses were used to test dehydration (Bun/Cr ratio>15), representing a predictor of infarct volume and stroke severity. CONCLUSION Bun/Cr ratio-based dehydration is associated with larger volumes of ischemic tissue measured using DWI and worse neurological deficit assessed by the NIHSS score in acute ischemic stroke.
Collapse
Affiliation(s)
- Huanyin Li
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai 201101, China.
| | - Hao Wang
- Department of Radiology, Minhang Hospital, Fudan University, Shanghai 201101, China.
| | - Qingyin Fu
- Department of Ultrasonography, Minhang Hospital, Fudan University, Shanghai 201101, China.
| | - Yang Liu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai 201101, China.
| | - Bin Song
- Department of Radiology, Minhang Hospital, Fudan University, Shanghai 201101, China.
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai 201101, China.
| | - Jixian Lin
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai 201101, China.
| |
Collapse
|
6
|
Buoite Stella A, Manganotti P. Enteral Nutrition and Hydration in Patients with Acute Stroke: Efficacy of an Automatic Pump System for Water Administration and Flushes-A Pilot Study. SENSORS (BASEL, SWITZERLAND) 2022; 22:8029. [PMID: 36298380 PMCID: PMC9609995 DOI: 10.3390/s22208029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/04/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Enteral nutrition is often prescribed in acute stroke to meet energy and fluid needs in patients with dysphagia. Tubes clogging represent a common complication of enteral formula delivery, requiring substitution and influencing nutrition administration. Frequent water flushes are recommended as one of the most effective procedures to prevent tube occlusion, but it might be time demanding and not consistently performed by the healthcare staff. This study aimed to assess the efficacy of an automatic flush pump, compared to a manual flush system, to prevent tubes' occlusions in acute-stroke patients, as this might affect nutrition and hydration. METHODS Gastrointestinal symptoms, nutrition and hydration biomarkers were also monitored to determine the different devices' safety. Sixty-two patients were included in the study and allocated to the "manual" or "automatic" flushes device. RESULTS The mean duration of data collection was 7 ± 2 days. Tube occlusions occurred in 22.6% of the patients in the "manual" group, whereas only one tube clogging was reported in the "automatic" group (p = 0.023). No significant differences between groups were reported for constipation and diarrhea frequency nor nutrition and hydration status. When the nurses were asked to simulate manual flush administration at the same frequency of the automatic device, they were able to meet the recommendations only 10% of the time. CONCLUSION This preliminary study suggests the efficacy of automatic flush systems to prevent enteral tube clogging, without affecting health status compared to standard manual flush systems.
Collapse
|
7
|
Zou Z, Liu K, Li Y, Yi S, Wang X, Yu C, Zhu H. The Application of the GP Model to Manage Controllable Risk Factors in Stroke Patients with Diabetes Can Effectively Improve the Prognosis and Reduce the Recurrence Rate. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:5413985. [PMID: 35966752 PMCID: PMC9374552 DOI: 10.1155/2022/5413985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/18/2022] [Indexed: 11/17/2022]
Abstract
Objective The aim of this study is to examine the impacts of general practice model (GP) on prognosis and recurrence of stroke patients with diabetes. Methods Ninety patients with stroke combined with diabetes mellitus admitted to our hospital from June 2019 to June 2020 were selected for the study and were randomly and equally divided into 45 cases each in the control and experimental groups for the prospective trial. The patients in the control group received routine treatment while those in the experimental group were treated with GP model. Comparison in treatment effects, patients satisfaction, psychological status, quality of life, glycosylated hemoglobin level, and stroke recurrence was carried out between the two groups. Results The experimental group showed markedly better treatment effects (P < 0.05), higher satisfaction degree (P < 0.05), higher HAD (P < 0.05), GQOLI-74 score (P < 0.05), and BI index (P < 0.05), lower level of glycosylated hemoglobin (P < 0.05), and much lower recurrence rate (P < 0.05), as compared to the control group. Conclusion The application of the GP model to manage controllable risk factors in stroke patients with diabetes can effectively improve the prognosis and reduce the recurrence rate, which is worthy of clinical application and promotion.
Collapse
Affiliation(s)
- Zhehua Zou
- Department of General Practice, The First Hospital of Qinhuangdao, Hebei 066000, China
| | - Kai Liu
- Department of Neurology, Qinhuangdao Haigang Hospital, Hebei 066000, China
| | - Yunjing Li
- Department of General Practice, The First Hospital of Qinhuangdao, Hebei 066000, China
| | - Shuangyan Yi
- Department of General Practice, The First Hospital of Qinhuangdao, Hebei 066000, China
| | - Xiaotang Wang
- Department of Otorhinolaryngology Head and Neck Surgery, The First Hospital of Qinhuangdao, Hebei 066000, China
| | - Changying Yu
- Department of General Practice, The First Hospital of Qinhuangdao, Hebei 066000, China
| | - Haiying Zhu
- Department of General Practice, The First Hospital of Qinhuangdao, Hebei 066000, China
| |
Collapse
|
8
|
Lehmann F, Schenk LM, Bernstock JD, Bode C, Borger V, Gessler F, Güresir E, Hamed M, Potthoff AL, Putensen C, Schneider M, Zimmermann J, Vatter H, Schuss P, Hadjiathanasiou A. Admission Dehydration Status Portends Adverse Short-Term Mortality in Patients with Spontaneous Intracerebral Hemorrhage. J Clin Med 2021; 10:jcm10245939. [PMID: 34945232 PMCID: PMC8708142 DOI: 10.3390/jcm10245939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 01/25/2023] Open
Abstract
The impact of dehydration at admission of patients with spontaneous intracerebral hemorrhage (ICH) on short-term mortality remains ambiguous due to scarce data. All of the consecutive patients with spontaneous ICH, who were referred to our neurovascular center in 2018/19, were assessed for hydration status on admission. Dehydration was defined by a blood urea-to-creatinine ratio > 80. In a cohort of 249 patients, 76 patients (31%) were dehydrated at the time of admission. The following factors were significantly and independently associated with increased 30-day mortality in multivariate analysis: “signs of cerebral herniation” (p = 0.008), “initial midline shift > 5 mm” (p < 0.001), “ICH score > 3” (p = 0.007), and “admission dehydration status” (p = 0.007). The results of the present study suggest that an admission dehydration status might constitute a significant and independent predictor of short-term mortality in patients with spontaneous ICH.
Collapse
Affiliation(s)
- Felix Lehmann
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, 53127 Bonn, Germany; (C.B.); (C.P.)
- Correspondence: ; Tel.: +49-228-287-14119
| | - Lorena M. Schenk
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Joshua D. Bernstock
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Christian Bode
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, 53127 Bonn, Germany; (C.B.); (C.P.)
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Florian Gessler
- Department of Neurosurgery, University Hospital Rostock, 18055 Rostock, Germany;
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Anna-Laura Potthoff
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, 53127 Bonn, Germany; (C.B.); (C.P.)
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Julian Zimmermann
- Department of Neurology, University Hospital Bonn, 53127 Bonn, Germany;
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Patrick Schuss
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Alexis Hadjiathanasiou
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| |
Collapse
|
9
|
Mimura Y, Shimizu Y, Oi H, Kurose S, Kudo S, Takata T, Mimura M, Funayama M. "Case series: ischemic stroke associated with dehydration and arteriosclerosis in individuals with severe anorexia nervosa". J Eat Disord 2021; 9:39. [PMID: 33743808 PMCID: PMC7981924 DOI: 10.1186/s40337-021-00393-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous reports have indicated that patients with anorexia nervosa (AN) are at a relatively high risk of developing vascular diseases, including cardiovascular events and venous thromboembolism. However, there have been no previous reports of the development of ischemic stroke during refeeding therapy in patients with severe AN. This report is aimed at reporting the characteristics of an ischemic stroke in patients with AN. CASE PRESENTATIONS Our study included 29 admissions by independent 19 female patients cases (19 patients), who received thorough medical, neurological, and psychiatric examinations. Two patients were diagnosed as having developed ischemic stroke; the first patient showed multiple infarctions in the brain, while the second showed symptomatic focal infarction. Our findings suggest that dehydration and arteriosclerosis, in association with severe malnutrition, could predispose to the development of ischemic stroke in patients with severe AN. CONCLUSIONS Development of ischemic stroke in patients with AN might be overlooked. Watching out for neurological signs would help in early diagnosis of ischemic stroke in patients with AN during refeeding. Specific etiology could induce ischemic stroke in patients with AN even if they have no common risk factors of ischemia.
Collapse
Affiliation(s)
- Yu Mimura
- Department of Neuropsychiatry, Japanese Red Cross Ashikaga Hospital, 49-1 Yobe-Cho, Ashikaga-shi, Tochigi, 326-0843, Japan. .,Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Yusuke Shimizu
- Department of Neuropsychiatry, Japanese Red Cross Ashikaga Hospital, 49-1 Yobe-Cho, Ashikaga-shi, Tochigi, 326-0843, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroki Oi
- Department of Neuropsychiatry, Japanese Red Cross Ashikaga Hospital, 49-1 Yobe-Cho, Ashikaga-shi, Tochigi, 326-0843, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shin Kurose
- Department of Neuropsychiatry, Japanese Red Cross Ashikaga Hospital, 49-1 Yobe-Cho, Ashikaga-shi, Tochigi, 326-0843, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shun Kudo
- Department of Neuropsychiatry, Japanese Red Cross Ashikaga Hospital, 49-1 Yobe-Cho, Ashikaga-shi, Tochigi, 326-0843, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Taketo Takata
- Department of Neuropsychiatry, Japanese Red Cross Ashikaga Hospital, 49-1 Yobe-Cho, Ashikaga-shi, Tochigi, 326-0843, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Michitaka Funayama
- Department of Neuropsychiatry, Japanese Red Cross Ashikaga Hospital, 49-1 Yobe-Cho, Ashikaga-shi, Tochigi, 326-0843, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| |
Collapse
|
10
|
Buoite Stella A, Ajčević M, Furlanis G, Lugnan C, Gaio M, Cillotto T, Scali I, Caruso P, Cova MA, Naccarato M, Manganotti P. A physiological perspective of the associations between hydration status and CTP neuroimaging parameters in hyper-acute ischaemic stroke patients. Clin Physiol Funct Imaging 2021; 41:235-244. [PMID: 33497005 DOI: 10.1111/cpf.12690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 12/17/2020] [Accepted: 01/18/2021] [Indexed: 12/16/2022]
Abstract
Hypohydration may be associated with vascular diseases, poor prognosis and worse outcomes in stroke. The underlying mechanisms have not yet been completely investigated, although some studies suggested potential associations with brain perfusion and collaterals status. Despite the potentially different mechanisms promoting serum or urine biomarkers of hypohydration, few studies have investigated both markers separately. A prospective descriptive study was conducted in stroke patients admitted to a stroke unit <4.5 h from symptoms onset. All patients underwent neurological evaluation and whole-brain computed tomography perfusion (CTP) upon admission. Blood and urine samples were immediately collected at admission, and patients were defined as "hypohydrated" (HYP) if blood urea nitrogen-to-creatinine ratio was >15 and "underhydrated" (UND) if urine osmolality was >500 mOsm/kg. CTP images were processed to calculate core, penumbra, their mismatch and total hypoperfused volume. Forty-six patients were included and were grouped according to hydration status. Despite no different NIHSS at baseline, at CTP HYP was independently associated with core-penumbra mismatch (β: -0.157, 95% CI: -0.305 to -0.009; p = .04), while UND was independently associated with the total hypoperfused volume (β: 31.502, 95% CI: 8.522-54.481; p = .01). Using CTP imaging, this study proposes a physiological insight of some possible mechanisms associated with the better outcomes observed in acute stroke patients when properly hydrated. These results suggest different associations between hydration status and CTP parameters depending on serum or urine biomarkers in the hyper-acute phase and encourage the association between hydration status and stroke characteristics.
Collapse
Affiliation(s)
- Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Miloš Ajčević
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy.,Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Carlo Lugnan
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Marina Gaio
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Tommaso Cillotto
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Ilario Scali
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Paola Caruso
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Maria Assunta Cova
- Radiology Unit, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Marcello Naccarato
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| |
Collapse
|
11
|
Gamba M, Moreira P, Borges N, Santos A, Afonso C, Amaral TF, Padrão P. Are older adults with excessive sodium intake at increased risk of hypohydration? J Hum Nutr Diet 2021; 34:834-840. [PMID: 33513297 DOI: 10.1111/jhn.12859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sodium intake is expected to affect water needs, although compensation mechanisms may not work efficiently particularly in older adults. The aim of this cross-sectional study was to quantify the association between sodium excretion and hydration status in a representative sample of Portuguese older adults. METHODS A cluster sampling approach was used, representing Portuguese older adults (≥65 years) according to sex, education level and region. From a sample size of 1500 participants, 1318 were eligible for the present analysis. A 24-h urine sample was collected, and volume, osmolality, creatinine and sodium were quantified. Free water reserve (FWR) was used to assess hydration status. Excessive sodium intake was defined as above 2000 mg day-1 as recommended by the World Health Organization. A multivariable binary logistic regression model was used to estimate the association between FWR and sodium excretion. Odds ratios (OR) and respective 95% confidence intervals (95% CI) were calculated. RESULTS Excessive sodium excretion was observed in 80.0% of women and 91.5% of men, whereas hypohydration affected 10.9% of women and 23.6% of men. After adjusting for confounders, excessive sodium excretion was associated with an increased risk of hypohydration among men (OR = 2.75; 95% CI = 1.06-7.15). CONCLUSIONS These results stress the positive association between excessive sodium intake and hypohydration in men and highlight the need for implementing strategies regarding the reduction of salt consumption and the promotion of water intake.
Collapse
Affiliation(s)
- Marta Gamba
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
| | - Pedro Moreira
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Centro de Atividade Física, Saúde e Lazer, Universidade do Porto, Porto, Portugal
| | - Nuno Borges
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal.,CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - Alejandro Santos
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal.,I3S-Instituto de Investigação e Inovação em Saúde, Porto, Portugal
| | - Cláudia Afonso
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Teresa F Amaral
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal.,UISPA-IDMEC, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - Patrícia Padrão
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| |
Collapse
|