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Barrueta Tenhunen A, Butler-Laporte G, Yoshiji S, Morrison DR, Nakanishi T, Chen Y, Forgetta V, Farjoun Y, Marton A, Titze JM, Nihlén S, Frithiof R, Lipcsey M, Richards JB, Hultström M. Metabolomic pattern associated with physical sequelae in patients presenting with respiratory symptoms validates the aestivation concept in dehydrated patients. Physiol Genomics 2024; 56:483-491. [PMID: 38738317 DOI: 10.1152/physiolgenomics.00021.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/17/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024] Open
Abstract
Hypertonic dehydration is associated with muscle wasting and synthesis of organic osmolytes. We recently showed a metabolic shift to amino acid production and urea cycle activation in coronavirus-2019 (COVID-19), consistent with the aestivation response. The aim of the present investigation was to validate the metabolic shift and development of long-term physical outcomes in the non-COVID cohort of the Biobanque Québécoise de la COVID-19 (BQC19). We included 824 patients from BQC19, where 571 patients had data of dehydration in the form of estimated osmolality (eOSM = 2Na + 2K + glucose + urea), and 284 patients had metabolome data and long-term follow-up. We correlated the degree of dehydration to mortality, invasive mechanical ventilation, acute kidney injury, and long-term symptoms. As found in the COVID cohort, higher eOSM correlated with a higher proportion of urea and glucose of total eOSM, and an enrichment of amino acids compared with other metabolites. Sex-stratified analysis indicated that women may show a weaker aestivation response. More severe dehydration was associated with mortality, invasive mechanical ventilation, and acute kidney injury during the acute illness. Importantly, more severe dehydration was associated with physical long-term symptoms but not mental long-term symptoms after adjustment for age, sex, and disease severity. Patients with water deficit in the form of increased eOSM tend to have more severe disease and experience more physical symptoms after an acute episode of care. This is associated with amino acid and urea production, indicating dehydration-induced muscle wasting.NEW & NOTEWORTHY We have previously shown that humans exhibit an aestivation-like response where dehydration leads to a metabolic shift to urea synthesis, which is associated with long-term weakness indicating muscle wasting. In the present study, we validate this response in a new cohort and present a deeper metabolomic analysis and pathway analysis. Finally, we present a sex-stratified analysis suggesting weaker aestivation in women. However, women show less dehydration, so the association warrants further study.
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Affiliation(s)
- Annelie Barrueta Tenhunen
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Guillaume Butler-Laporte
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Lady Davis Institute of Medical Research, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Satoshi Yoshiji
- Lady Davis Institute of Medical Research, Jewish General Hospital, McGill University, Montréal, Québec, Canada
- Department of Human Genetics, McGill University, Montréal, Québec, Canada
- Kyoto-McGill International Collaborative Program in Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Research Fellow, Japan Society for the Promotion of Science, Tokyo, Japan
| | - Dave R Morrison
- Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Human Genetics, McGill University, Montréal, Québec, Canada
| | - Tomoko Nakanishi
- Lady Davis Institute of Medical Research, Jewish General Hospital, McGill University, Montréal, Québec, Canada
- Department of Human Genetics, McGill University, Montréal, Québec, Canada
- Kyoto-McGill International Collaborative Program in Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Research Fellow, Japan Society for the Promotion of Science, Tokyo, Japan
| | - Yiheng Chen
- Lady Davis Institute of Medical Research, Jewish General Hospital, McGill University, Montréal, Québec, Canada
- Department of Human Genetics, McGill University, Montréal, Québec, Canada
| | - Vincenzo Forgetta
- Lady Davis Institute of Medical Research, Jewish General Hospital, McGill University, Montréal, Québec, Canada
- Department of Human Genetics, McGill University, Montréal, Québec, Canada
- 5 Prime Sciences, Montréal, Québec, Canada
| | - Yossi Farjoun
- Lady Davis Institute of Medical Research, Jewish General Hospital, McGill University, Montréal, Québec, Canada
- 5 Prime Sciences, Montréal, Québec, Canada
- The Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States
- Fulcrum Genomics, Boulder, Colorado, United States
| | - Adriana Marton
- Program in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore, Singapore
| | - Jens Marc Titze
- Program in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore, Singapore
- Division of Nephrology, Duke University Medical Center, Durham, North Carolina, United States
| | - Sandra Nihlén
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Robert Frithiof
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Miklos Lipcsey
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - J Brent Richards
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Lady Davis Institute of Medical Research, Jewish General Hospital, McGill University, Montréal, Québec, Canada
- Department of Human Genetics, McGill University, Montréal, Québec, Canada
- Department of Twin Research, King's College London, London, United Kingdom
- 5 Prime Sciences, Montréal, Québec, Canada
| | - Michael Hultström
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Lady Davis Institute of Medical Research, Jewish General Hospital, McGill University, Montréal, Québec, Canada
- Integrative Physiology, Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
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Chen CH, Lee AT, Yang JT, Tsai YH, Lin LC, Huang YC. An observational study on salivary conductivity for fluid status assessment and clinical relevance in acute ischemic stroke during intravenous fluid hydration. Sci Rep 2023; 13:22460. [PMID: 38105313 PMCID: PMC10725879 DOI: 10.1038/s41598-023-49957-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023] Open
Abstract
The body fluid status in acute stroke is a crucial determinant in early stroke recovery but a real-time method to monitor body fluid status is not available. This study aims to evaluate the relationship between salivary conductivity and body fluid status during the period of intravenous fluid hydration. Between June 2020 to August 2022, patients presenting with clinical signs of stroke at the emergency department were enrolled. Salivary conductivities were measured before and 3 h after intravenous hydration. Patients were considered responsive if their salivary conductivities at 3 h decreased by more than 20% compared to their baseline values. Stroke severity was assessed using the National Institutes of Health Stroke Scale, and early neurological improvement was defined as a decrease of ≥ 2 points within 72 h of admission. Among 108 recruited patients, there were 35 of stroke mimics, 6 of transient ischemic attack and 67 of acute ischemic stroke. Salivary conductivity was significantly decreased after hydration in all patients (9008 versus 8118 µs/cm, p = 0.030). Among patients with acute ischemic stroke, the responsive group, showed a higher rate of early neurological improvement within 3 days compared to the non-responsive group (37% versus 10%, p = 0.009). In a multivariate logistic regression model, a decrease in salivary conductivity of 20% or more was found to be an independent factor associated with early neurological improvement (odds ratio 5.42, 95% confidence interval 1.31-22.5, p = 0.020). Real-time salivary conductivity might be a potential indicator of hydration status of the patient with acute ischemic stroke.
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Affiliation(s)
- Chun-Hao Chen
- Department of Orthopedic, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
| | - An-Ting Lee
- Department of Anesthesiology, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
| | - Jen-Tsung Yang
- Department of Neurosurgery, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Radiology, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Leng-Chieh Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Puzi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Chu Huang
- Department of Neurology, Chang Gung Memorial Hospital, Chiayi Branch, No. 6 West Chia-Pu Road, Putz, Chiayi County, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Murray J, Gunasekaran S, Doeltgen S, George S, Harvey G. Implementing a Screen-Clean-Hydrate bundle of care for improving swallow screening, oral health, and hydration in acute stroke: Protocol for a Type 2 hybrid-effectiveness pre-post study. Res Nurs Health 2023; 46:566-575. [PMID: 37837417 DOI: 10.1002/nur.22346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/13/2023] [Accepted: 09/29/2023] [Indexed: 10/16/2023]
Abstract
Stroke clinical guidelines recommend care processes that optimize patient outcomes and minimize hospital-acquired complications. However, audits and surveys illustrate that recommended care is not always consistently or thoroughly implemented. This paper outlines the methods for implementing and evaluating a new bundle of care. Screen-Clean-Hydrate bundles together recommendations from the Australian Clinical Guidelines for Stroke Management and supplements these with evidence-informed best practice from the literature for: swallow screening within 4 h of presentation to hospital (Screen); oral health assessment and delivery of oral care (Clean); and hydration assessment and management (Hydrate). The study is a pre-post Type 2 hybrid effectiveness/implementation design with an embedded process evaluation, which will be conducted in two acute stroke units in a capital city of Australia. The integrated-Promoting Action on Research Implementation in Health Services (iPARIHS) framework will be used to guide study design, conduct, and evaluation. Clinical effectiveness will be measured by rates of hospital-acquired complications and proxy measures of cost (length of stay, procedure costs) for 60 patient participants pre- and postimplementation. Implementation outcomes will focus on acceptability, feasibility, uptake and fidelity, and identification of barriers and enablers to implementation through staff interviews, medical record audits, and researcher field notes. Due to its design as a hybrid effectiveness/implementation study, once completed, the study will provide information on both intervention and implementation effectiveness, including details of successful and unsuccessful multidisciplinary implementation strategies. This will inform a larger multisite effectiveness/implementation trial for future upscale, leading to improved compliance with stroke guidelines and therefore stroke outcomes.
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Affiliation(s)
- Joanne Murray
- Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Caring Futures Institute, Flinders University, Adelaide, Australia
- Swallowing Neurorehabilitation Research Laboratory, Flinders University, Adelaide, Australia
| | - Sulekha Gunasekaran
- Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Sebastian Doeltgen
- Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Caring Futures Institute, Flinders University, Adelaide, Australia
- Swallowing Neurorehabilitation Research Laboratory, Flinders University, Adelaide, Australia
| | - Stacey George
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Gillian Harvey
- Caring Futures Institute, Flinders University, Adelaide, Australia
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Miller C, Jones SP, Bangee M, Martinez-Garduno CM, Brady MC, Cadilhac DA, Dale S, McInnes E, Middleton S, Watkins CL, Lightbody CE. Hydration and nutrition care practices in stroke: findings from the UK and Australia. BMC Nurs 2023; 22:403. [PMID: 37891567 PMCID: PMC10604400 DOI: 10.1186/s12912-023-01575-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/22/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Dehydration and malnutrition are common in hospitalised patients following stroke leading to poor outcomes including increased mortality. Little is known about hydration and nutrition care practices in hospital to avoid dehydration or malnutrition, and how these practices vary in different countries. This study sought to capture how the hydration and nutrition needs of patients' post-stroke are assessed and managed in the United Kingdom (UK) and Australia (AUS). AIM To examine and compare current in-hospital hydration and nutrition care practice for patients with stroke in the UK and Australia. METHODS A cross-sectional survey was conducted between April and November 2019. Questionnaires were mailed to stroke specialist nurses in UK and Australian hospitals providing post-stroke inpatient acute care or rehabilitation. Non-respondents were contacted up to five times. RESULTS We received 150/174 (86%) completed surveys from hospitals in the UK, and 120/162 (74%) in Australia. Of the 270 responding hospitals, 96% reported undertaking assessment of hydration status during an admission, with nurses most likely to complete assessments (85%). The most common methods of admission assessment were visual assessment of the patient (UK 62%; AUS 58%), weight (UK 52%; AUS 52%), and body mass index (UK 47%; AUS 42%). Almost all (99%) sites reported that nutrition status was assessed at some point during admission, and these were mainly completed by nurses (91%). Use of standardised nutrition screening tools were more common in the UK (91%) than Australia (60%). Similar proportions of hydration management decisions were made by physicians (UK 84%; AUS 83%), and nutrition management decisions by dietitians (UK 98%; AUS 97%). CONCLUSION Despite broadly similar hydration and nutrition care practices after stroke in the UK and Australia, some variability was identified. Although nutrition assessment was more often informed by structured screening tools, the routine assessment of hydration was generally not. Nurses were responsible for assessment and monitoring, while dietitians and physicians undertook decision-making regarding management. Hydration care could be improved through the development of standardised assessment tools. This study highlights the need for increased implementation and use of evidence-based protocols in stroke hydration and nutrition care to improve patient outcomes.
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Affiliation(s)
- Colette Miller
- Stroke Research Team, School of Nursing & Midwifery, University of Central Lancashire, Preston, PR1 2HE, UK.
| | - Stephanie P Jones
- Stroke Research Team, School of Nursing & Midwifery, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Munirah Bangee
- Stroke Research Team, School of Nursing & Midwifery, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Cintia Mayel Martinez-Garduno
- Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, Australia
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, VIC, Melbourne, Australia
| | - Simeon Dale
- Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, VIC, Melbourne, Australia
| | - Elizabeth McInnes
- Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, VIC, Melbourne, Australia
| | - Sandy Middleton
- Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, VIC, Melbourne, Australia
| | - Caroline L Watkins
- Stroke Research Team, School of Nursing & Midwifery, University of Central Lancashire, Preston, PR1 2HE, UK
| | - C Elizabeth Lightbody
- Stroke Research Team, School of Nursing & Midwifery, University of Central Lancashire, Preston, PR1 2HE, UK
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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5
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Miller C, Mcloughlin AS, Benedetto V, Christian DL, Jones SP, Smith E, Watkins CL. Diagnosis and treatment of dehydration after stroke: A synthesis of existing evidence. BRITISH JOURNAL OF NEUROSCIENCE NURSING 2023; 19:S24-S32. [PMID: 38812878 PMCID: PMC7616033 DOI: 10.12968/bjnn.2023.19.sup5.s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Dehydration after stroke is associated with poor health outcomes, increased mortality, and poses a significant economic burden to health services. Yet research suggests that monitoring and assessment of hydration status is not routinely undertaken. In this commentary, we critically appraise a systematic review which aimed to synthesise the existing evidence regarding diagnosis and treatment of dehydration after stroke. The review discusses common measures of dehydration, describes studies evaluating rehydration treatments, and highlights the link between dehydration and poorer health outcomes in both human and animal studies. The reviewers suggest, future research should focus on determining a single, validated, objective measure to clinically diagnose dehydration in stroke patients. Research designs should include clearly defined patient characteristics, type and severity of stroke, and type and time point of dehydration measurement, to enable comparison between studies. Management of hydration status is a crucial element of acute stroke care which should be routinely practiced.
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Affiliation(s)
- Colette Miller
- IMPlementation and Capacity building Team (IMPaCT), Applied Health Research Hub, University of Central of Central Lancashire (UCLan), Preston
- Stroke Research Team, School of Nursing and Midwifery, UCLan, Preston
- NIHR Applied Research Collaboration North West Coast (ARC NWC), UCLan, Preston
| | - Alison S.R. Mcloughlin
- IMPlementation and Capacity building Team (IMPaCT), Applied Health Research Hub, University of Central of Central Lancashire (UCLan), Preston
- NIHR Applied Research Collaboration North West Coast (ARC NWC), UCLan, Preston
| | - Valerio Benedetto
- NIHR Applied Research Collaboration North West Coast (ARC NWC), UCLan, Preston
- Methodological Innovation, Development, Adaptation & Support Theme (MIDAS), Applied Health Research Hub, University of Central
| | - Danielle L. Christian
- IMPlementation and Capacity building Team (IMPaCT), Applied Health Research Hub, University of Central of Central Lancashire (UCLan), Preston
- NIHR Applied Research Collaboration North West Coast (ARC NWC), UCLan, Preston
| | | | - Eleanor Smith
- NIHR Applied Research Collaboration North West Coast (ARC NWC), UCLan, Preston
| | - Caroline L. Watkins
- IMPlementation and Capacity building Team (IMPaCT), Applied Health Research Hub, University of Central of Central Lancashire (UCLan), Preston
- Stroke Research Team, School of Nursing and Midwifery, UCLan, Preston
- NIHR Applied Research Collaboration North West Coast (ARC NWC), UCLan, Preston
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Lucijanic M, Krecak I, Cicic D, Milosevic M, Vukoja D, Kovacevic I, Marasovic I, Sedinic Lacko M, Bakovic J, Jonjic Z, Vasilj T, Stojic J, Atic A. Hypoosmolar and hyperosmolar COVID-19 patients are predisposed to dismal clinical outcomes. Scand J Clin Lab Invest 2023; 83:397-402. [PMID: 37529905 DOI: 10.1080/00365513.2023.2241368] [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: 04/16/2023] [Revised: 07/09/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
We aimed to investigate the associations of hypo- and hyperosmolarity at hospital admission with clinical characteristics and outcomes in 5645 consecutive hospitalized COVID-19 patients treated at a tertiary-level institution. Serum osmolarity was calculated as 2x Na (mmol/L) + urea (mmol/L) + glucose (mmol/L), with normal range from 275 to 295 mOsm/L. Median serum osmolarity was 292.9 mOsm/L with 51.8% normoosmolar, 5.3% hypoosmolar and 42.9% hyperosmolar patients present at the time of hospital admission. Hypoosmolarity was driven by hyponatremia, and was associated with the presence of chronic liver disease, liver cirrhosis, active malignancy and epilepsy. Hyperosmolarity was driven by an increase in urea and glucose and was associated with the presence of chronic metabolic and cardiovascular comorbidities. Both hypo- and hyperosmolar patients presented with more severe COVID-19 symptoms, higher inflammatory status, and experienced higher mortality in comparison to normoosmolar patients. In multivariate analysis, hypoosmolarity (adjusted odds ratio (aOR)=1.39, p = 0.024) and hyperosmolarity (aOR = 1.9, p < 0.001) remained significantly associated with higher mortality independently of older age, male sex, higher Charlson Comorbidity Index and more severe COVID-19. Disruptions in serum osmolarity are frequent in COVID-19 patients, may be easy to detect and target therapeutically, and thus potentially moderate associateds poor prognosis.
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Affiliation(s)
- Marko Lucijanic
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivan Krecak
- Internal Medicine Department, General Hospital Sibenik-Knin County, Sibenik, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - David Cicic
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Marko Milosevic
- Gastroenterology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Damir Vukoja
- Pulmonology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Ivona Kovacevic
- Pulmonology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Ivan Marasovic
- Pulmonology Department, University Hospital Dubrava, Zagreb, Croatia
| | | | - Josip Bakovic
- Abdominal Surgery Department, University Hospital Dubrava, Zagreb, Croatia
| | - Zeljko Jonjic
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Tamara Vasilj
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Josip Stojic
- Gastroenterology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Armin Atic
- Nephrology Department, University Hospital Center Zagreb, Zagreb, Croatia
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7
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Chen Y, Peng Y, Zhang X, Chen L, Lin Y. Influence of Impaired Hydration Status on Postoperative in-Hospital Death in Patients with Acute Type A Aortic Dissection. Int J Gen Med 2023; 16:4419-4428. [PMID: 37795309 PMCID: PMC10547000 DOI: 10.2147/ijgm.s426612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/15/2023] [Indexed: 10/06/2023] Open
Abstract
Background The hydration state of the body is getting more and more attention from researchers. The purpose of this study is to investigate the relationship between impaired hydration status and postoperative hospitalization death in patients with A AAD. Methods From January 2019 to October 2021, the clinical data of 299 patients undergoing A AAD surgery were retrospectively analyzed. Patients were divided into normal hydration group, imminent dehydration group and current dehydration group according to the dehydration standard at admission. Univariate and multivariate logistic regression analysis were used to determine the independent risk factors for in-hospital death of patients with A AAD. Results Postoperative in-hospital death in A AAD patients was significantly more common in the imminent and current dehydration groups (>295mmol/L) (26.7% vs 11.9%; P=0.001). The length of ICU stay was significantly longer in the impending and current dehydration groups (P<0.05). After controlling for other factors by multivariate logistic regression analysis, the results showed that the group of impending and current dehydration (>295) (OR=3.61, 95% confidence interval [CI]: 1.61-8.06; P=0.002), CRRT (OR=10.55, 95%[CI]: 3.59-31.01; P<0.001), lactic acid (OR=1.25, 95%[CI]: 1.13-1.38; P<0.001), CAD (OR=5.27, 95%[CI]: 1.12-24.80; P=0.035) was an independent risk factor for in-hospital death in A AAD patients. Albumin (OR=0.92, 95%[CI]: 0.85-0.99; P=0.040) is a protective factor. Conclusion The presence of high serum osmotic pressure on admission of A AAD patients can independently predict postoperative death, and the impaired body hydration status should be paid attention to.
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Affiliation(s)
- Yaqin Chen
- School of Nursing, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Yanchun Peng
- Department of Nursing, Union Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Xuecui Zhang
- School of Nursing, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Liangwan Chen
- Department of Cardiac Surgery, Union Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Yanjuan Lin
- Department of Nursing, Union Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
- Department of Cardiac Surgery Nursing, Union Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
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8
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Zhang D, Li Q, Liu J, Ma L, Ye J, Hu G, Li G. Calculated plasma volume status is associated with poor outcomes in acute ischemic stroke treated with endovascular treatment. Front Neurol 2023; 14:1229331. [PMID: 37576016 PMCID: PMC10415678 DOI: 10.3389/fneur.2023.1229331] [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: 05/26/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023] Open
Abstract
Background and purpose The impact of calculated plasma volume status (PVS) on the prognosis of acute ischemic stroke treated with endovascular treatment (EVT) remains undetermined. This study aimed to investigate the association between PVS and 90 days functional outcomes after EVT. Methods We enrolled patients treated with EVT in the anterior circulation from a prospective registry. The endpoint was a modified Rankin scale score of ≥3 points at 90 days after EVT. We used multivariable logistic regression models to investigate the association between PVS and poor outcomes. We used the restricted cubic spline to present the linearity between PVS and poor outcomes. Results Among the 187 enrolled patients (median age, 65 years; 35.8% women), a total of 81 patients (43.3%) experienced poor outcomes at 90 days. In multivariable analyses, PVS was associated with poor outcomes despite increasing confounding factors (odds ratio, 3.157; 95% confidence interval, 1.942-5.534; P < 0.001). The restricted cubic spline revealed a positive correlation between PVS and the risk of poor outcomes after EVT (P for nonlinearity = 0.021). Conclusion Our study found that an elevated PVS value was associated with poor outcomes after EVT. Further prospective cohorts were warranted to evaluate the utility of PVS in AIS treated with EVT.
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Affiliation(s)
| | | | | | | | | | | | - Guangzong Li
- Department of Neurology, The Sixth People's Hospital of Chengdu, Chengdu, China
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9
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Bond VE, Doeltgen S, Kleinig T, Murray J. Dysphagia-related acute stroke complications: A retrospective observational cohort study. J Stroke Cerebrovasc Dis 2023; 32:107123. [PMID: 37058873 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107123] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 04/16/2023] Open
Abstract
OBJECTIVES Post-stroke dysphagia is associated with aspiration pneumonia, but strategies intended to mitigate this complication, such as oral intake modifications, may unintentionally lead to dehydration-related complications such as urinary tract infections (UTIs) and constipation. This study aimed to determine the rates of aspiration pneumonia, dehydration, UTI and constipation in a large cohort of acute stroke patients and the independent predictors of each complication. MATERIALS AND METHODS Data were extracted retrospectively for 31,953 acute stroke patients admitted to six hospitals in Adelaide, South Australia over a 20-year period. Tests of difference compared rates of complications between patients with and without dysphagia. Multiple logistic regression modelling explored variables that significantly predicted each complication. RESULTS In this consecutive cohort of acute stroke patients, with a mean (SD) age of 73.8 (13.8) years and 70.2% presenting with ischaemic stroke, rates of complications were: aspiration pneumonia (6.5%); dehydration (6.7%); UTI (10.1%); and constipation (4.4%). Each complication was significantly more prevalent for patients with dysphagia compared to those without. Controlling for demographic and other clinical variables, the presence of dysphagia independently predicted aspiration pneumonia (OR=2.61, 95% CI 2.21-3.07; p<.001), dehydration (OR=2.05, 95% CI 1.76-2.38; p<.001), UTI (OR=1.34, 95% CI 1.16-1.56; p<.001), and constipation (OR=1.30, 95% CI 1.07-1.59; p=.009). Additional predictive factors were increased age and prolonged hospitalisation. CONCLUSIONS Aspiration pneumonia, dehydration, UTI, and constipation are common acute sequelae of stroke and independently associated with dysphagia. Future dysphagia intervention initiatives may utilise these reported complication rates to evaluate their impact on all four adverse health complications.
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Affiliation(s)
- Verity E Bond
- Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Sebastian Doeltgen
- Speech Pathology, College of Nursing and Health Sciences, Swallowing Neurorehabilitation Research Laboratory, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Timothy Kleinig
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Australia
| | - Joanne Murray
- Speech Pathology, College of Nursing and Health Sciences, Swallowing Neurorehabilitation Research Laboratory, Caring Futures Institute, Flinders University, Adelaide, Australia.
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10
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Miller C, Gibson JME, Jones S, Timoroska AM, Maley A, Romagnoli E, Chesworth BM, Watkins CL. How is hydration assessed and managed in acute stroke? A qualitative study of healthcare staff's knowledge, attitudes and experiences. J Clin Nurs 2023; 32:1089-1102. [PMID: 35437838 DOI: 10.1111/jocn.16332] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore healthcare staff's experiences of how dehydration is identified and managed in hospitalised patients after acute stroke, and facilitators and challenges to optimising hydration. BACKGROUND Optimal hydration post-stroke reduces the risk of neurological deterioration and other complications. Patients are at risk of dehydration in acute stroke, particularly those with dysphagia. DESIGN A descriptive qualitative study reported following the COREQ guidelines. METHODS Semi-structured interviews, utilising patient vignettes, were conducted in 2018 (Apr-Oct) with a purposive sample of 30 multidisciplinary staff members from two UK stroke units. Interviews were digitally recorded and transcribed verbatim. Content analysis identified common themes which were mapped to the Theoretical Domains Framework and the Behaviour Change Wheel. RESULTS The themes were mapped to twelve of the fourteen domains in the Theoretical Domains Framework. Participants believed that inadequate hydration management had potentially serious consequences, and described complex knowledge, skills and cognitive elements to effective hydration care. Participants felt that maintaining hydration was a multidisciplinary responsibility requiring good communication. Although the performance of initial dysphagia screening was reinforced by external audit, other areas of post-stroke hydration management were not; notably, there was no established method of assessing hydration. Barriers to maintaining good hydration included lack of staff, out-of-hours working patterns, low priority given to hydration, patients' comorbidities and complex post-stroke disabilities such as dysphagia, aphasia, inattention and hemiparesis. CONCLUSION Findings highlighted the importance of assessing and maintaining hydration but identified barriers to, and variation in, clinical practice. To provide optimal care, barriers to the prevention and treatment of dehydration after stroke must be further understood and addressed. RELEVANCE TO CLINICAL PRACTICE Multidisciplinary teamwork is important in hydration care after stroke, but clarity is required about the specific contributions of each team member. Without this, hydration care becomes 'everybody's and nobody's job'.
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Affiliation(s)
- Colette Miller
- Stroke Research Team, University of Central Lancashire, Preston, UK
| | | | - Stephanie Jones
- Stroke Research Team, University of Central Lancashire, Preston, UK
| | - Anne-Marie Timoroska
- Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
| | - Alex Maley
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool Victoria Hospital, Blackpool, UK
| | - Elisa Romagnoli
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool Victoria Hospital, Blackpool, UK
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11
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Heng G, Zhang J, Dong Y, Jia J, Huang B, Shen Y, Wang D, Lan Z, Zhang J, Fu T, Jin W. Increased ICU mortality in septic shock patients with hypo- or hyper- serum osmolarity: A retrospective study. Front Med (Lausanne) 2023; 10:1083769. [PMID: 36817778 PMCID: PMC9928738 DOI: 10.3389/fmed.2023.1083769] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
Background While many factors that are associated with increased mortality in septic shock patients have been identified, the effects of serum osmolarity on the outcomes of ICU patients with septic shock have not yet been studied. Methods The present study was designed to examine the association of serum osmolarity with ICU 28-day mortality in ICU patients with septic shock. Adult patients diagnosed with septic shock from the MIMIC-IV database were selected in this study. The serum osmolarity was calculated synchronously according to the serum concentrations of Na+, K+, glucose, and urea nitrogen. Results In the present study, a significant difference was observed between the 28-day mortality of septic shock patients with hypo-osmolarity, hyper-osmolarity, and normal osmolarity (30.8%, 34.9%, and 23.0%, respectively, p < 0.001), which were detected at ICU admission. After propensity score matching (PSM) for basic characteristics, the relatively higher mortality was still observed in the hypo-osmolarity and hyper-osmolarity groups, compared to normal osmolarity group (30.6%, 30.0% vs. 21.7%, p = 0.009). Furthermore, we found that transforming the hyper-osmolarity into normal osmolarity by fluid therapy on day 2 and 3 decreased this mortality. Conclusion The serum osmolarity disorder is markedly associated with increased 28-day mortality in septic shock patients.
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Affiliation(s)
- Gang Heng
- Department of General Surgery, PLA Middle Military Command General Hospital, Wuhan, China
| | - Jiasi Zhang
- Center of Haematology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yi Dong
- Department of General Surgery, PLA Middle Military Command General Hospital, Wuhan, China,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jiankun Jia
- Department of General Surgery, PLA Middle Military Command General Hospital, Wuhan, China
| | - Benqi Huang
- Department of Quality Education, Jiangsu Vocational College of Electronics and Information, Huaian, China
| | - Yanbing Shen
- Department of General Surgery, PLA Middle Military Command General Hospital, Wuhan, China
| | - Dan Wang
- Department of General Surgery, PLA Middle Military Command General Hospital, Wuhan, China
| | - Zhen Lan
- Department of General Surgery, PLA Middle Military Command General Hospital, Wuhan, China
| | - Jianxin Zhang
- Department of General Surgery, PLA Middle Military Command General Hospital, Wuhan, China,*Correspondence: Jianxin Zhang,
| | - Tao Fu
- Department of General Surgery, PLA Middle Military Command General Hospital, Wuhan, China,Tao Fu,
| | - Weidong Jin
- Department of General Surgery, PLA Middle Military Command General Hospital, Wuhan, China,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China,Weidong Jin,
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12
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Armstrong EJ, Carpenter KJ. A Standardized Ward Round Proforma Improves Documentation in a Specialist Stroke Unit. Cureus 2022; 14:e31931. [DOI: 10.7759/cureus.31931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 11/28/2022] Open
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13
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Mehta A, De Paola L, Pana TA, Carter B, Soiza RL, Kafri MW, Potter JF, Mamas MA, Myint PK. The relationship between nutritional status at the time of stroke on adverse outcomes: a systematic review and meta-analysis of prospective cohort studies. Nutr Rev 2022; 80:2275-2287. [PMID: 35640017 PMCID: PMC9647329 DOI: 10.1093/nutrit/nuac034] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
CONTEXT AND OBJECTIVE The impact of existing malnutrition on stroke outcomes is poorly recognised and treated. Evidence was systematically reviewed and quantified by meta-analysis. METHODS MEDLINE, EMBASE and Web of Science were searched from inception to 11 January 2021 and updated in July. Prospective cohort studies, in English, evaluating anthropometric and biomarkers of nutrition on stroke outcomes were included. Risk of bias was assessed using the Scottish Intercollegiate Guidelines Network checklist. RESULTS Twenty-six studies (n = 156 249) were eligible (follow-up: One month-14 years). Underweight patients had increased risk of long-term mortality (adjusted hazard ratio = 1.65,1.41-1.95), whilst overweight (0.80,0.74-0.86) and obese patients (0.80,0.75-0.85) had decreased risk compared to normal weight. Odds of mortality decreased in those with high serum albumin (odds ratio = 0.29,0.18-0.48) and increased with low serum albumin (odds ratio = 3.46,1.78-6.74) compared to normal serum albumin (30-35 g/L). Being malnourished compared to well-nourished, as assessed by the Subjective Global Assessment (SGA) or by a combination of anthropometric and biochemical markers increased all-cause mortality (odds ratio = 2.38,1.85-3.06) and poor functional status (adjusted odds ratio = 2.21,1.40-3.49). CONCLUSION Nutritional status at the time of stroke predicts adverse stroke outcomes.
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Affiliation(s)
- Arnav Mehta
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Lorenzo De Paola
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Tiberiu A Pana
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Roy L Soiza
- Aberdeen Cardiovascular & Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, Scotland, United Kingdom
| | - Mohannad W Kafri
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Department of Nutrition & Dietetics, Birzeit University, Birzeit, West Bank, Palestine
| | - John F Potter
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
| | - Phyo K Myint
- P. K. Myint, School of Medicine, Medical Sciences and Nutrition Foresterhill, Room 4:013, Polwarth Building, Aberdeen AB25 2ZD, Scotland, UK. E-mail:
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14
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The Role of Seawater and Saline Solutions in Treatment of Upper Respiratory Conditions. Mar Drugs 2022; 20:md20050330. [PMID: 35621981 PMCID: PMC9147352 DOI: 10.3390/md20050330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 02/07/2023] Open
Abstract
The history of saline nasal irrigation (SNI) is indeed a long one, beginning from the ancient Ayurvedic practices and gaining a foothold in the west at the beginning of the 20th century. Today, there is a growing number of papers covering the effects of SNI, from in vitro studies to randomized clinical trials and literature overviews. Based on the recommendations of most of the European and American professional associations, seawater, alone or in combination with other preparations, has its place in the treatment of numerous conditions of the upper respiratory tract (URT), primarily chronic (rhino)sinusitis, allergic rhinitis, acute URT infections and postoperative recovery. Additionally, taking into account its multiple mechanisms of action and mounting evidence from recent studies, locally applied seawater preparations may have an important role in the prevention of viral and bacterial infections of the URT. In this review we discuss results published in the past years focusing on seawater preparations and their use in clinical and everyday conditions, since such products provide the benefits of additional ions vs. saline, have an excellent safety profile and are recommended by most professional associations in the field of otorhinolaryngology.
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15
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Bahouth MN, Saylor D, Hillis AE, Gottesman RF. The Impact of Mean Arterial Pressure and Volume Contraction in With Acute Ischemic Stroke. Front Neurol 2022; 13:766305. [PMID: 35345409 PMCID: PMC8957081 DOI: 10.3389/fneur.2022.766305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 01/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Hydration at the time of stroke may impact functional outcomes. We sought to investigate the relationship between blood pressure, hydration status, and stroke severity in patients with acute ischemic stroke (AIS). Methods We evaluated hydration status, determined by blood urea nitrogen (BUN)/creatinine ratio, in consecutive patients with AIS from a single comprehensive stroke center. Baseline mean arterial pressure (MAP) was analyzed using a linear spline with a knot at 90 mmHg. Baseline stroke severity was defined based on admission NIH Stroke Scale scores (NIHSSS) and MRI diffusion-weighted imaging. Results Among 108 eligible subjects, 55 (51%) presented in a volume contracted state. In adjusted models, in the total sample, for every 10 mmHg higher MAP up to 90 mmHg, NIHSSS was 2.8 points lower (p = 0.053), without further statistically significant association between MAP above 90 and NIHSSS. This relationship was entirely driven by the individuals in a volume contracted state: MAP was not associated with NIHSSS in individuals who were euvolemic. For individuals in a volume contracted state, each 10 mmHg higher MAP, up to 90 mmHg, was associated with 6.9 points lower NIHSSS (95% CI −11.1, −2.6). MAP values above 90 mmHg were not related to NIHSSS in either dehydrated or euvolemic patients. Conclusions Lower MAP contributes to more severe stroke in patients who are volume contracted, but not those who are euvolemic, suggesting that hydration status and blood pressure may jointly contribute to the outcome. Hydration status should be considered when setting blood pressure goals for patients with AIS.
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Affiliation(s)
- Mona N Bahouth
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States.,School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Deanna Saylor
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Argye E Hillis
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Rebecca F Gottesman
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States.,School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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16
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Jiang WF, Deng ML. Prognostic impact of blood urea nitrogen/creatinine ratio changes in patients with acute ischemic stroke. Clin Neurol Neurosurg 2022; 215:107204. [DOI: 10.1016/j.clineuro.2022.107204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/14/2022] [Accepted: 03/07/2022] [Indexed: 12/01/2022]
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17
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ESPEN practical guideline: Clinical nutrition and hydration in geriatrics. Clin Nutr 2022; 41:958-989. [DOI: 10.1016/j.clnu.2022.01.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/15/2022]
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18
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Siahaan YMT, Hartoyo V, Muljono M, Budisulistyo T. Physiological Aspects of Plasma Osmolarity and its Association with the Clinical Severity of Ischemic Stroke Evaluated with the NIHSS: A Cross-sectional Study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Ischemic stroke is one of the leading causes of mortality and disability worldwide. Recent studies have observed that some physiological factors play a pivotal role in determining stroke severity, which can be assessed using the National Institutes of Health Stroke Scale (NIHSS) score. Hydration status is one of the most frequently studied physiological factors and can be evaluated by measuring plasma osmolarity levels. However, studies regarding the association between plasma osmolarity and stroke severity remain scarce.
AIM: This study aimed to investigate the association between increased blood plasma osmolarity levels and the NIHSS scores in patients with acute ischemic stroke.
METHODS: This cross-sectional study obtained medical records of subjects aged 18–80 years old who were diagnosed with their first acute ischemic stroke from January to March 2021 at the Siloam Hospitals Lippo Village Tangerang in Indonesia.
RESULTS: The NIHSS scores of patients with acute ischemic stroke were observed to have a moderate positive correlation with plasma osmolarity (p = 0.004, r = 0.309). Patients with an elevated plasma osmolarity had higher NIHSS scores than those with normal levels of plasma osmolarity (8.52 ± 5.01 vs. 6.03 ± 3.72).
CONCLUSIONS: Higher levels of plasma osmolarity among acute ischemic stroke subjects correlated positively with increased NIHSS scores on admission.
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19
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Çelik D, Yildiz M, Çifci A. Serum osmolarity does not predict mortality in patients with respiratory failure. Medicine (Baltimore) 2022; 101:e28840. [PMID: 35147129 PMCID: PMC8830864 DOI: 10.1097/md.0000000000028840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/27/2022] [Indexed: 01/04/2023] Open
Abstract
We aimed to determine the parameters that affect mortality in pulmonary intensive care units that are faster and inexpensive to determine than existing scoring systems. The relationship between serum osmolarity and prognosis was demonstrated for predialysis patients, in acute pulmonary embolism, heart failure, acute coronary syndrome, myocardial infarction, and acute spontaneous intracerebral hemorrhage in the literature. We hypothesized that serum osmolarity, which is routinely evaluated, may have prognostic significance in patients with respiratory failure.This study comprised 449 patients treated in the Pulmonary Intensive Care Clinic (PICU) of our hospital between January 1, 2020, and December 31, 2020. The modified Charlson Comorbidity Index (mCCI), Acute Physiology and Chronic Health Assessment (APACHE II), Sequential Organ Failure Evaluation Score (SOFA), Nutrition Risk Screening 2002 (NRS-2002), and hospitalization serum osmolarity levels were measured.Of the 449 patients included in the study, 65% (n = 292) were female and the mean age of all patients was 69.86 ± 1.72 years. About 83.1% (n = 373) of the patients included in the study were discharged with good recovery. About 4.9% (n = 22) were transferred to the ward because their intensive care needs were over. About 6.9% (n = 31) were transferred to the tertiary intensive care unit after their status deteriorated. About 5.1% (n = 23) died in the PICU. In the mortality group, APACHE II (P = .005), mCCI (P < .001), NRS-2002 total score (P < .001), and SOFA score (P < .001) were significantly higher. There was no statistically significant difference between the groups in terms of serum osmolarity levels.Although we could not determine serum osmolarity as a practical method to predict patient prognosis in this study, we assume that our results will guide future studies on this subject.
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Affiliation(s)
- Deniz Çelik
- Alanya Alaaddin Keykubat University, Faculty of Medicine, Department of Pulmonology, Alanya, Antalya, Turkey
| | - Murat Yildiz
- University of Health Sciences Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, Department of Pulmonology, Ankara, Turkey
| | - Ayşe Çifci
- University of Health Sciences Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, Department of Pulmonology, Ankara, Turkey
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20
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Akbulut N, Ozturk V, Men S, Arslan A, Tuncer Issı Z, Yaka E, Kutluk K. Factors associated with early improvement after intravenous thrombolytic treatment in acute ischemic stroke. Neurol Res 2021; 44:353-361. [PMID: 34706632 DOI: 10.1080/01616412.2021.1996980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE : The aim of this study was to determine the factors associated with early neurological improvement (ENI) in patients who experienced acute ischemic stroke and were treated with intravenous recombinant tissue plasminogen activator (IV rt-PA), and determine the relationship with the outcome at the first control. METHOD : This study included 377 patients who were treated with IV rt-PA in Izmir Dokuz Eylül University Hospital between January 2010 and October 2018. ENI was defined as a 4 or more improvement in the National Institutes of Health Stroke Scale (NIHSS) score in the first hour, the twenty-fourth hour and the seventh day when compared to the pretreatment phase. The modified Rankin Scale (mRS) 0-1 score was defined as 'very good outcome'. RESULTS : The basal NIHSS (p=0.003, p=0.003, p=0.022) was high in the first hour, twenty-fourth hour, and seventh day ENI groups. Blood urea nitrogen (BUN) level was low in the first- and twenty-fourth-hour ENI groups (p=0.007, p=0.020). Furthermore, admission glucose was low at the twenty-fourth hour and on the seventh day ENI groups (p=0.005, p=0.048). A high infarct volume was observed on magnetic resonance imaging (MRI) at the twenty-fourth hour and on the seventh day non-ENI groups (p= <0.001, p= <0.001). CONCLUSION : Management of factors associated with ENI and determination of treatment strategies accordingly are important for obtaining a better clinical outcome. It can help quickly select patients, who, even though they will not respond to rt-PA, may be appropriate candidates for bridging therapy.
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Affiliation(s)
- Nurcan Akbulut
- Institution providing healthcare in the second level region, Bayburt State Hospital, Neurology Clinic, Bayburt, Turkey
| | - Vesile Ozturk
- Department of Neurology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Suleyman Men
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Atakan Arslan
- Institution providing healthcare in the second level region, Kemalpasa State Hospital, Radiology Clinic, Izmir, Turkey
| | - Zeynep Tuncer Issı
- 3rd level institution, Sakarya Research and Training Hospital, Neurology and Pain Management Clinic, Sakarya, Turkey
| | - Erdem Yaka
- Department of Neurology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Kursad Kutluk
- Department of Neurology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
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Ramesh J, Rajesh M, Varghese J, Reddy SLS. Calculated plasma osmolality at hospital admission correlates well with eGFR and D-Dimer, a simple outcome predictor and guiding tool for management of severe COVID-19 patients. Diabetes Metab Syndr 2021; 15:102240. [PMID: 34403950 PMCID: PMC8353972 DOI: 10.1016/j.dsx.2021.102240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 07/30/2021] [Accepted: 08/01/2021] [Indexed: 11/05/2022]
Abstract
AIMS To evaluate calculated total plasma osmolality as a marker of outcome prediction, fluid and metabolic balance, thrombotic risk in severe COVID-19 patients. METHODS Retrospective data of RT-PCR confirmed hospitalized severe COVID-19 patients (total: n = 175 patients, including diabetic subset: n = 102) were analyzed. Clinically applicable cut-offs were derived using receiver operating characteristic (ROC) curve analysis for calculated total osmolality, eGFR, and D-dimer, and their correlations were studied. RESULTS Among 175 severe COVID-19 patients, a significant association with mortality was seen with respect to calculated total osmolality (p < 0.001), eGFR (p < 0.001), and D-dimer (p < 0.001). In the total cohort, applicable cut-offs based on ROC curve in predicting outcome were, for total osmolality 299 mosm/kg (area under the curve (AUC)-0.773, odds ratio (OR)-1.09), eGFR 61.5 ml/min/m2 (AUC-0.789, OR-0.96), D-dimer 5.13 (AUC-0.814, OR-2.65) respectively. In diabetic subset, the cut-offs for total osmolality were 298 mosm/kg (AUC-0.794, OR-1.12), eGFR 44.9 ml/min/m2 (AUC-0.774, OR-0.96) and D-dimer 1.59 (AUC-0.769, OR-1.52) respectively. CONCLUSIONS Applicable cut-offs for calculated total plasma osmolality, eGFR, and D-dimer predicts clinical outcome in severe COVID-19 with and without diabetes. Correlation studies validated calculated total osmolality as a marker of the combined effect of fluid and metabolic imbalance, compromised renal function and hypercoagulability.
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Affiliation(s)
- Jayanthy Ramesh
- Department of Endocrinology, King George Hospital, Andhra Medical College, Vishakapatnam, India.
| | - Moganti Rajesh
- Department of Endocrinology, King George Hospital, Andhra Medical College, Vishakapatnam, India.
| | - Johann Varghese
- Department of Endocrinology, King George Hospital, Andhra Medical College, Vishakapatnam, India.
| | - S L Sagar Reddy
- Department of Endocrinology, King George Hospital, Andhra Medical College, Vishakapatnam, India.
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22
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Admission Hydration Status and Ischemic Stroke Outcome-Experience from a National Registry of Hospitalized Stroke Patients. J Clin Med 2021; 10:jcm10153292. [PMID: 34362078 PMCID: PMC8347030 DOI: 10.3390/jcm10153292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/04/2021] [Accepted: 07/22/2021] [Indexed: 01/01/2023] Open
Abstract
Reduced intravascular volume upon ischemic stroke (IS) admission has been associated with in-hospital complications, disability, and reduced survival. We aimed to evaluate the association of the urea-to-creatinine ratio (UCR) with disability or death at discharge, length of stay, in-hospital complications, and mortality during the first year. Using a national registry, we identified hospitalized IS patients without renal failure. Disability or death at discharge, length of stay, in-hospital complications, and mortality during the first year were studied by UCR, and associations between UCR levels and each outcome were assessed adjusting for age, sex, stroke severity, comorbidities, use of statins, and use of diuretics. In total, 2212 patients were included. Levels (median (25–75%)) for the main study variables were: urea 5.16 (3.66–6.83) mmol/L; creatinine 80 (64–92) µmol/L; and UCR 65 (58–74). Levels of UCR were significantly higher in patients with disability or death at discharge (p < 0.0001), those with complications during hospitalization (p = 0.03), those with infection during hospitalization (p = 0.0003), and those dead at 1 year (p < 0.0001). Analysis by UCR quartile showed that rates of disability or death at discharge, infections, complications overall, and death at 1 year in patients with UCR in the 4th quartile were significantly higher than in others. Risk-factor-adjusted analysis by UCR quartiles demonstrated an inconsistent independent association between UCR and disability or death after ischemic stroke. A high 1-year mortality rate was observed in IS patients with elevated UCR, yet this finding was not statistically significant after controlling for risk factors. Our study shows inconsistent associations between hydration status and poor functional status at discharge, and no association with length of stay, in-hospital complications (infectious and overall), and 1-year mortality.
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Zhai G, Wang J, Liu Y, Zhou Y. The Association Between Plasma Osmolarity and In-hospital Mortality in Cardiac Intensive Care Unit Patients. Front Cardiovasc Med 2021; 8:692764. [PMID: 34277741 PMCID: PMC8282930 DOI: 10.3389/fcvm.2021.692764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/09/2021] [Indexed: 01/08/2023] Open
Abstract
Objectives: Plasma osmolarity is a common marker used for evaluating the balance of fluid and electrolyte in clinical practice, and it has been proven to be related to prognosis of many diseases. The purpose of this study was to identify the association between plasma osmolarity and in-hospital mortality in cardiac intensive care unit (CICU) patients. Method: All of the patients were divided into seven groups stratified by plasma osmolarity, and the group with 290–300 mmol/L osmolarity was used as a reference group. Primary outcome was in-hospital mortality. The local weighted regression (Lowess) smoothing curve was drawn to determine the “U”-shaped relationship between plasma osmolarity and in-hospital mortality. Binary logistic regression analysis was performed to determine the effect of plasma osmolarity on the risk of in-hospital mortality. Result: Overall, 7,060 CICU patients were enrolled. A “U”-shaped relationship between plasma osmolarity and in-hospital mortality was observed using the Lowess smoothing curve. The lowest in-hospital mortality (7.2%) was observed in the reference group. whereas hyposmolarity (<280 mmol/L vs. 290–300 mmol/L: 13.0 vs. 7.2%) and hyperosmolarity (≥330 mmol/L vs. 290–300 mmol/L: 31.6 vs. 7.2%) had higher in-hospital mortality. After adjusting for possible confounding variables with binary logistic regression analysis, both hyposmolarity (<280 mmol/L vs. 290–300 mmol/L: OR, 95% CI: 1.76, 1.08–2.85, P = 0.023) and hyperosmolarity (≥330 mmol/L vs. 290–300 mmol/L: OR, 95% CI: 1.65, 1.08–2.52, P = 0.021) were independently associated with an increased risk of in-hospital mortality. Moreover, lengths of CICU and hospital stays were prolonged in patients with hyposmolarity or hyperosmolarity. Conclusion: A “U”-shaped relationship between plasma osmolarity and in-hospital mortality was observed. Both hyposmolarity and hyperosmolarity were independently associated with the increased risk of in-hospital mortality.
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Affiliation(s)
- Guangyao Zhai
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jianlong Wang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuyang Liu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yujie Zhou
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Liu M, Deng Y, Cheng Y, Hao Z, Wu S, Liu M. Association between Plasma Osmolality and Case Fatality within 1 Year after Severe Acute Ischemic Stroke. Yonsei Med J 2021; 62:600-607. [PMID: 34164957 PMCID: PMC8236343 DOI: 10.3349/ymj.2021.62.7.600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/15/2021] [Accepted: 04/05/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Plasma osmolality, a marker of dehydration, is associated with cardiovascular mortality. We aimed to investigate whether elevated plasma osmolality is associated with case fatality within 1 year after severe acute ischemic stroke. MATERIALS AND METHODS We included severe ischemic stroke patients (defined as National Institutes of Health Stroke Scale ≥15 score) within 24 hours from symptom onset admitted to the Department of Neurology, West China Hospital between January 2017 and June 2019. Admission plasma osmolality was calculated using the equation 1.86*(sodium+potassium)+1.15*glucose+urea+14. Elevated plasma osmolality was defined as plasma osmolality >296 mOsm/kg, indicating a state of dehydration. Study outcomes included 3-month and 1-year case fatalities. Multivariable logistic regression was performed to determine independent associations between plasma osmolality and case fatalities at different time points. RESULTS A total of 265 patients with severe acute ischemic stroke were included. The mean age was 71.2±13.1 years, with 51.3% being males. Among the included patients, case fatalities were recorded for 31.7% (84/265) at 3 months and 39.6% (105/265) at 1 year. Elevated plasma osmolality (dehydration) was associated with 3-month case fatality [odds ratio (OR) 1.98, 95% confidence interval (CI) 1.07-3.66, p=0.029], but not 1-year case fatality (OR 1.51, 95% CI 0.84-2.72, p=0.165), after full adjustment for confounding factors. CONCLUSION Elevated plasma osmolality was independently associated with 3-month case fatality, but not 1-year case fatality, for severe acute ischemic stroke.
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Affiliation(s)
- Meng Liu
- Center of Cerebrovascular Disease, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yilun Deng
- Center of Cerebrovascular Disease, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yajun Cheng
- Center of Cerebrovascular Disease, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Zilong Hao
- Center of Cerebrovascular Disease, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Simiao Wu
- Center of Cerebrovascular Disease, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Liu
- Center of Cerebrovascular Disease, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
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Abstract
OBJECTIVES Acute ischemic stroke patients are at risk of acute kidney injury due to volume depletion, contrast exposure, and preexisting comorbid diseases. We determined the occurrence rate and identified predictors associated with acute kidney injury in acute ischemic stroke patients. SETTING Multiple specialized ICUs within academic medical centers. DESIGN Post hoc analysis of pooled data from prospective randomized clinical trials. PATIENTS Acute ischemic stroke patients recruited within 3 hours or within 5 hours of symptom onset. INTERVENTIONS IV recombinant tissue plasminogen activator, endovascular treatment, IV albumin, or placebo. MEASUREMENTS AND MAIN RESULTS Serum creatinine levels from baseline and within day 5 or discharge were used to classify acute kidney injury classification into stages. Any increase in serum creatinine was seen in 697 (36.1%) and acute kidney injury was seen in 68 (3.5%) of 1,931 patients with acute ischemic stroke. Severity of acute kidney injury was grade I, II, and III in 3.1%, 0.4%, and 0.05% patients, respectively. Patients with albumin (5.5% compared with 2.6%; p = 0.001), preexisting hypertension (4.3% compared with 1.5%; p = 0.0041), and preexisting renal disease (9.1% compared with 3.0%; p < 0.0001) had higher risk of acute kidney injury. The risk of acute kidney injury was lower between those who either underwent CT angiography (2.0% compared with 4.7%; p = 0.0017) or endovascular treatment (1.6% compared with 4.2%; p = 0.0071). In the multivariate analysis, hypertension (odds ratio, 2.6; 95% CI, 1.2-5.6) and renal disease (odds ratio, 3.5; 95% CI, 1.9-6.5) were associated with acute kidney injury. The risk of death was significantly higher among patients with acute kidney injury (odds ratio, 2.7; 95% CI, 1.4-4.9) after adjusting for age and National Institutes of Health Stroke Scale score strata. CONCLUSIONS The occurrence rate of acute kidney injury in acute ischemic stroke patients was low and was not higher in patients who underwent CT angiogram or those who received endovascular treatment. Occurrence of acute kidney injury increased the risk of death within 3 months among acute ischemic stroke patients.
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Buaprasert P, Piyapaisarn S, Vanichkulbodee A, Kamsom A, Sri-On J. Prevalence and risk factors of hypertonic dehydration among older patients admitted to the emergency department: A prospective cross-sectional study. Geriatr Gerontol Int 2021; 21:485-491. [PMID: 33847031 DOI: 10.1111/ggi.14168] [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: 11/28/2020] [Revised: 01/23/2021] [Accepted: 03/28/2021] [Indexed: 11/28/2022]
Abstract
AIM The prevalence of hypertonic dehydration (HD) among community-dwelling and hospitalized populations has been evaluated. However, to our knowledge, no study had previously focused on older patients admitted to the emergency department (ED). The present study aimed to evaluate the prevalence, risk factors and short-term outcomes of HD among Thai older patients admitted to the ED. METHODS This was a prospective cross-sectional study at one urban ED in Thailand. Patients aged ≥65 years who were admitted to the ED were enrolled into the study. Data including clinical hydration status, Charlson Comorbidity Index (CCI) score, activities of daily living score, current use of medications, laboratory examination results and serum osmolarity level were collected. HD was defined as a serum osmolarity level of >300 mOsm/kg. The short-term outcomes were a 30-day ED revisit, hospital readmission and mortality rates. RESULTS In total, 80 (21.6%) of 370 patients presented with HD. A CCI score of ≥5 was found associated with HD among older patients (adjusted odds ratio: 1.82; 95% confidence interval: 1.03-3.21). The ED revisit rates were 18.1% in the dehydrated group and 10.9% in the non-dehydrated group. The hospital readmission rates were 8.3% in the dehydrated group and 10.6% in the non-dehydrated group. Furthermore, the 30-day mortality rates were 6.9% and 5.3% in the dehydrated and non-dehydrated groups, respectively. CONCLUSIONS One-fifth of older patients admitted to the ED presented with HD. A CCI score of ≥5 was considered a risk factor of HD. Moreover, further studies should focus on the long-term outcomes of HD and risk reduction. Geriatr Gerontol Int 2021; 21: 485-491.
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Affiliation(s)
- Phudit Buaprasert
- The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sawangwarach Piyapaisarn
- Department of Emergency Medicine, Srinagarind Hospital, Khon Kaen University, Khonkaen, Thailand
| | - Alissara Vanichkulbodee
- The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Anucha Kamsom
- The Department of Biostatistic, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Jiraporn Sri-On
- The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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Effects of Early Rehydration on Brain Perfusion and Infarct Core after Middle Cerebral Artery Occlusion in Rats. Brain Sci 2021; 11:brainsci11040439. [PMID: 33805440 PMCID: PMC8066368 DOI: 10.3390/brainsci11040439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 12/05/2022] Open
Abstract
Imaging evidence for the effect of rehydration on cerebral perfusion and brain ischemia has never been proposed in the literature. This study aimed to test the hypothesis that early rehydration treatment can improve cerebral perfusion and decrease infarct volume, consequently reducing mortality of dehydrated stroke animals. Methods: Thirty dehydrated experimental rats were randomly assigned to either a rehydration or control group after middle cerebral artery occlusion (MCAO). Diffusion-weighted imaging and dynamic contrast enhancement perfusion imaging were performed at 30 min and 6 h after MCAO using a 9.4T MR imaging scanner to measure the infarct volume and brain perfusion. Results: The survival rates after the first MRI scan were 91.7% for the rehydration group and 58.3% for the control group (p = 0.059). The survival rates after the second MRI scan were 66.7% for the rehydration group, and 8.3% of the control group survived (p = 0.003). The infarct volume of the rehydration group was significantly smaller than control group at 30 min after MCAO (p = 0.007). The delay time and time to maximum were significantly shorter in the rehydration group at 30 min (p = 0.004 and 0.035, respectively). Conclusions: The findings suggest that early rehydration therapy can decrease the infarct volume, shorten the delay time of cerebral perfusion, and increase survival of dehydrated ischemic-stroke rats. This preliminary study provided imaging evidence that more intensive early hydration therapies and reperfusion strategies may be necessary for acute stroke patients with dehydrated status.
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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.
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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
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Gou L, Xiang M, Ran X, Wang F, Zhang S, Li S, Dong K, Chen X, Huang Y, Meng C, Fan Q, Yang Y, Yu X, Ma D, Yin P. Hyperosmolarity Deserves More Attention in Critically Ill COVID-19 Patients with Diabetes: A Cohort-Based Study. Diabetes Metab Syndr Obes 2021; 14:47-58. [PMID: 33442281 PMCID: PMC7800461 DOI: 10.2147/dmso.s284148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/01/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Recently, a cluster of pneumonia caused by SARS-CoV-2 were identified in Wuhan and spread throughout the world. More information about risk factors for mortality of critically ill patients infected with SARS-CoV-2 remain to be evaluated. METHODS We included adult patients confirmed with SARS-CoV-2 infection who were critically ill and admitted to the intensive care unit (ICU) of Tongji Hospital in Wuhan from Feb 4, 2020 to Feb 20, 2020. Data were collected and compared between patients who died and improved. Logistic regression was used to explore the risk factors for death of SARS-CoV-2-infected critically ill patients. RESULTS A total of 160 critically ill patients with SARS-CoV-2 infection were included, of which 146 patients with appeared outcomes were included into the final analysis. The random blood glucose, serum sodium and effective plasma osmolarity were higher in deceased patients, especially in patients with diabetes. There were 7 patients with diabetes with hyperosmolar status and all of them were deceased. Multivariable regression revealed that older age (odds ratio 4.28, 95% CI 1.01-18.20; p = 0.049), higher C-reactive protein (odds ratio 1.01, 1.00-1.03; p = 0.024), higher interleukin-6 (odds ratio 1.01, 1.00-1.03; p = 0.0323), and d-dimer greater than 1 μg/mL (odds ratio 1.10, 1.01-1.20; p = 0.032) at admission were associated with increased odds of death. CONCLUSION In conclusion, hyperosmolarity needs more attention and may contribute to mortality in critically ill patients with COVID-19, especially in those with diabetes. Older age, inflammatory response, and thrombosis may be risk factors for death of critically ill patients with SARS-CoV-2 infection.
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Affiliation(s)
- Luoning Gou
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Ming Xiang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Xiao Ran
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Fen Wang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Shujun Zhang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Shusheng Li
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Kun Dong
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Xi Chen
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Yangxin Huang
- College of Public Health, University of South Florida, Tampa, Florida, The United States
| | - Chengzhen Meng
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Qian Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Yan Yang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Xuefeng Yu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Delin Ma
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- Delin Ma Email
| | - Ping Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- Correspondence: Ping Yin; Delin Ma Tongji Medical College, Huazhong University of Science and Technology, 13 Hongkong Road, Wuhan, 430030Hubei, People’s Republic of ChinaTel + 86-27-83692832Fax +86-27-83692333 Email
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Wham C, Smithers A, Kruger R, Mazahery H, Richter M. Factors associated with low-intake dehydration among older inpatients: A pilot study. Australas J Ageing 2020; 40:e163-e172. [PMID: 33295084 DOI: 10.1111/ajag.12894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/26/2020] [Accepted: 10/31/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To assess fluid intake among older inpatients and factors associated with low-intake dehydration. METHODS Daily fluid intake and access were assessed within the 24-hour period, and blood was drawn to measure serum osmolality. RESULTS Of 89 patients, 16% and 27% had serum osmolality ≥ 300 (dehydrated) and 295-299 mOsm/kg (impending dehydration), respectively. Median (IQR) total fluid intake was 1.7 (1.6, 1.9) L/day. Fluid intake from beverages (P = .06) and water (P = .02) was higher in hydrated than impending/dehydrated patients. Of all fluid sources, only water intake was associated with hydration status (P = .02). The adjusted odds of serum osmolality ≥ 295 were increased for patients in the first (<0.3 L, P = .007) and second (0.3-0.8 L, P = .04) tertiles of water intake than those in the third tertile (≥0.8 L). Bladder control difficulty was associated with lower water intake (P = .03). CONCLUSION Monitoring water intake and assisting patients with bladder control difficulty may be key strategies to maintain hydration.
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Affiliation(s)
- Carol Wham
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Allie Smithers
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Rozanne Kruger
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Hajar Mazahery
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Marilize Richter
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
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Pala AA, Urcun YS. Effect of calculated plasma osmolality and atherogenic index of plasma on carotid artery blood flow velocities. Vascular 2020; 29:527-534. [PMID: 33245024 DOI: 10.1177/1708538120963922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The increase in carotid artery blood flow velocity is a measure of the severity of the carotid artery stenosis caused by atherosclerosis. Carotid artery stenosis is progressive and is of great importance due to the risk of stroke it creates. As an alternative to radiological examinations in these patients, patient follow-up can be facilitated by associating novel laboratory parameters with the severity of stenosis. In this study, we aimed to investigate the effect of the calculated plasma osmolality and atherogenic index of plasma on carotid artery blood flow velocities in patients with carotid artery stenosis. METHODS A total of 161 patients diagnosed with carotid artery stenosis who admitted to our clinic between May 2018 and May 2020 were retrospectively analyzed. According to the carotid artery blood flow velocities measured with the Doppler ultrasonography, the patients were divided into two groups as "Normal flow velocity group" (n = 62) and "Increased flow velocity group" (n = 99). RESULTS The calculated plasma osmolality, atherogenic index of plasma, and mean platelet volume were significantly associated with increased carotid artery blood flow velocity (p < 0.001, p < 0.001, p = 0.006; respectively). Calculated plasma osmolality and atherogenic index of plasma were identified as independent predictors of increase in carotid artery blood flow velocity (p < 0.001, p < 0.001; respectively). In the Receiver Operating Characteristic curve analysis, the plasma osmolality cut-off value, which predicts the increase in carotid artery blood flow velocity was found to be 291.45 mOsm/kg (Area Under the Curve: 0.746, p < 0.001, 65.7% sensitivity, and 67.7% specificity), and atherogenic index of plasma cut-off value was 0.20 (Area Under the Curve: 0.735, p < 0.001, 65.7% sensitivity, and 66.1% specificity). CONCLUSION There was a significant relationship between the increase in carotid artery blood flow velocity and the increase in plasma osmolality and atherogenic index of plasma values. As a result, we can predict the increase in carotid artery blood flow velocity, that is, the increase in the severity of the carotid artery stenosis, with plasma osmolality and atherogenic index of plasma values that can be calculated simply from routine biochemical tests.
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Affiliation(s)
- Arda Aybars Pala
- Department of Cardiovascular Surgery, Adiyaman Training and Research Hospital, Adiyaman, Turkey
| | - Yusuf Salim Urcun
- Department of Cardiovascular Surgery, Adiyaman Training and Research Hospital, Adiyaman, Turkey
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Tamburri LM, Hollender KD, Orzano D. Protecting Patient Safety and Preventing Modifiable Complications After Acute Ischemic Stroke. Crit Care Nurse 2020; 40:56-65. [PMID: 32006035 DOI: 10.4037/ccn2020859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
TOPIC Protecting patient safety and preventing modifiable complications after acute ischemic stroke. CLINICAL RELEVANCE Stroke is a leading cause of death and disability in adults. Stroke survivors often experience a variety of deficits related to mobility, nutrition, immunity, mood, and cognition. These post-stroke complications and residual effects can adversely affect safety, placing the patient at risk for further injury. In order to develop a plan of care that protects patient safety, critical care and progressive care nurses must understand the unique needs of this patient population. PURPOSE To describe selected ischemic stroke-related physiological changes, how these changes contribute to safety risks, and methods of enhancing patient safety. CONTENT COVERED Stroke physiology and stroke-specific interventions that can enable nurses to reduce the risk of falls, dysphagia, malnutrition, dehydration, altered glucose metabolism, device-related infections, aspiration pneumonia, delirium, and depression.
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Affiliation(s)
- Linda M Tamburri
- Linda M. Tamburri is a clinical nurse specialist, Magnet/Quality Department, critical care float pool, and specialty care transport unit, Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Kimberly D Hollender
- Kimberly D. Hollender and Devon Orzano are acute care nurse practitioners, stroke neurology and neurocritical care, Robert Wood Johnson University Hospital
| | - Devon Orzano
- Kimberly D. Hollender and Devon Orzano are acute care nurse practitioners, stroke neurology and neurocritical care, Robert Wood Johnson University Hospital
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El-Sharkawy AM, Devonald MAJ, Humes DJ, Sahota O, Lobo DN. Hyperosmolar dehydration: A predictor of kidney injury and outcome in hospitalised older adults. Clin Nutr 2020; 39:2593-2599. [PMID: 31801657 PMCID: PMC7403861 DOI: 10.1016/j.clnu.2019.11.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND & AIMS Hospitalised older adults are vulnerable to dehydration. However, the prevalence of hyperosmolar dehydration (HD) and its impact on outcome is unknown. Serum osmolality is not measured routinely but osmolarity, a validated alternative, can be calculated using routinely measured serum biochemistry. This study aimed to use calculated osmolarity to measure the prevalence of HD (serum osmolarity >300 mOsm/l) and assess its impact on acute kidney injury (AKI) and outcome in hospitalised older adults. METHODS This retrospective cohort study used data from a UK teaching hospital retrieved from the electronic database relating to all medical emergency admissions of patients aged ≥ 65 years admitted between 1st May 2011 and 31st October 2013. Using these data, Charlson comorbidity index (CCI), National Early Warning Score (NEWS), length of hospital stay (LOS) and mortality were determined. Osmolarity was calculated using the equation of Krahn and Khajuria. RESULTS A total of 6632 patients were identified; 27% had HD, 39% of whom had AKI. HD was associated with a median (Q1, Q3) LOS of 5 (1, 12) days compared with 3 (1, 9) days in the euhydrated group, P < 0.001. Adjusted Cox-regression analysis demonstrated that patients with HD were four-times more likely to develop AKI 12-24 h after admission [Hazards Ratio (95% Confidence Interval) 4.5 (3.5-5.6), P < 0.001], and had 60% greater 30-day mortality [1.6 (1.4-1.9), P < 0.001], compared with those who were euhydrated. CONCLUSION HD is common in hospitalised older adults and is associated with increased LOS, risk of AKI and mortality. Further work is required to assess the validity of osmolality or osmolarity as an early predictor of AKI and the impact of HD on outcome prospectively.
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Affiliation(s)
- Ahmed M El-Sharkawy
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Mark A J Devonald
- Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, City Campus, Nottingham, NG5 1PB, UK
| | - David J Humes
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK; Division of Epidemiology and Public Health, University of Nottingham, City Campus, Nottingham NG5 1PB, UK
| | - Opinder Sahota
- Department of Elderly Medicine, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
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Hamrick I, Norton D, Birstler J, Chen G, Cruz L, Hanrahan L. Association Between Dehydration and Falls. Mayo Clin Proc Innov Qual Outcomes 2020; 4:259-265. [PMID: 32542217 PMCID: PMC7283563 DOI: 10.1016/j.mayocpiqo.2020.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To determine whether there is an association between dehydration and falls in adults 65 years and older. Patients and Methods We used University of Wisconsin Health electronic health records from October 1, 2011 to September 30, 2015 to conduct a retrospective cohort study of Midwestern patients 65 years and older and examined the association between dehydration at baseline (defined as serum urea nitrogen to creatinine ratio > 20, sodium level > 145 mg/dL, urine specific gravity > 1.030, or serum osmolality > 295 mOsm/kg) and falls within 3 years after baseline while accounting for prescriptions of loop diuretic, antidepression, anticholinergic, antipsychotic, and benzodiazepine/hypnotic medications and demographic characteristics, using logistic regression. Results Of 30,634 patients, 37.9% (n=11,622) were dehydrated, 11.4% (n=3483) had a fall during follow-up, and 11.7% (n=3572) died during the follow-up period. We found a positive association of dehydration with falls alone (odds ratio [OR], 1.13; P=.002). For the outcome of falls or death, dehydration was positively associated (OR, 1.13; P=.001), along with loop diuretics (OR, 1.26; P<.001) and antipsychotic medications (OR, 1.52; P<.001). Conclusion More than one-third of older adults in this cohort were dehydrated, with a strong association between dehydration and falls. Understanding and addressing the risks associated with dehydration, including falls, has potential for improving quality of life for patients as they age.
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Affiliation(s)
- Irene Hamrick
- University of Cincinnati College of Medicine, Cincinnati, OH
| | - Derek Norton
- Department of Biostatistics and Informatics, University of Wisconsin, Madison
| | - Jen Birstler
- Department of Biostatistics and Informatics, University of Wisconsin, Madison
| | - Guanhua Chen
- Department of Biostatistics and Informatics, University of Wisconsin, Madison
| | - Laura Cruz
- Department of Family Medicine and Community Health, University of Wisconsin, Madison
| | - Lawrence Hanrahan
- Department of Family Medicine and Community Health, University of Wisconsin, Madison
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Lacey J, Corbett J, Shepherd A, Dubois A, Hughes F, White D, Tipton M, Mythen M, Montgomery H. Thirst-guided participant-controlled intravenous fluid rehydration: a single blind, randomised crossover study. Br J Anaesth 2020; 124:403-410. [PMID: 32014238 DOI: 10.1016/j.bja.2019.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/01/2019] [Accepted: 12/12/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Dehydration is common in hospitals and is associated with increased mortality and morbidity. Clinical assessment and diagnostic measures of dehydration are unreliable. We sought to investigate the novel concept that individuals might control their own intravenous rehydration, guided by thirst. METHODS We performed a single-blind, counterbalanced, randomised cross-over trial. Ten healthy male volunteers of mean age 26 (standard deviation [sd] 10.5) yr were dehydrated by 3-5% of their baseline body mass via exercising in the heat (35°C, 60% humidity). This was followed by a 4 h participant-controlled intravenous rehydration: individuals triggered up to six fluid boluses (4% dextrose in 0.18% sodium chloride) per hour in response to thirst. Participants undertook two blinded rehydration protocols which differed only by bolus volume: 50 ml (low volume [LV]) or 200 ml (high volume [HV]). Each hour during the rehydration phase, plasma osmolality (pOsm) was measured and thirst score recorded. Nude body mass was measured at baseline, after dehydration, and after the rehydration phase. RESULTS In both conditions, the mean dehydration-related body mass loss was 3.9%. Thirst score was strongly associated with pOsm (within-subject r=0.74) and demand for fluid decreased as pOsm corrected. In the HV condition, participants rapidly rehydrated themselves (mean fluid delivered 3060 vs 981 ml in the LV condition) to body mass and pOsm no different to their euhydrated state. CONCLUSION Healthy individuals appear able to rely on thirst to manage intravenous fluid intake. Future work must now focus on whether patient-controlled intravenous fluids could represent a paradigm shift in the management of hydration in the clinical setting. CLINICAL TRIAL REGISTRATION NCT03932890.
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Affiliation(s)
- Jonathan Lacey
- Institute of Sport Exercise & Health, University College London, London, UK; St George's Hospital NHS Trust, London, UK.
| | - Jo Corbett
- Department of Sport & Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Ant Shepherd
- Department of Sport & Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Andre Dubois
- British Antarctic Survey Medical Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Fintan Hughes
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Danny White
- Department of Sport & Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Mike Tipton
- Department of Sport & Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Michael Mythen
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Hugh Montgomery
- Institute of Sport Exercise & Health, University College London, London, UK
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Underhydration Is Associated with Obesity, Chronic Diseases, and Death Within 3 to 6 Years in the U.S. Population Aged 51-70 Years. Nutrients 2020; 12:nu12040905. [PMID: 32224908 PMCID: PMC7230456 DOI: 10.3390/nu12040905] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 12/14/2022] Open
Abstract
Nationally representative data from the National Health and Nutrition Examination Survey (NHANES) indicate that over 65% of adults aged 51–70 years in the U.S. do not meet hydration criteria. They have hyponatremia (serum sodium < 135 mmol/L) and/or underhydration (serum sodium >145 mmol/L, spot urine volume <50 mL, and/or spot urine osmolality ≥500 mmol/kg). To explore potential public health implications of not meeting hydration criteria, data from the NHANES 2009–2012 and National Center for Health Statistics Linked Mortality Files for fasting adults aged 51–70 years (sample n = 1200) were used to determine if hyponatremia and/or underhydration were cross-sectionally associated with chronic health conditions and/or longitudinally associated with chronic disease mortality. Underhydration accounted for 97% of the population group not meeting hydration criteria. In weighted multivariable adjusted Poisson models, underhydration was significantly associated with increased prevalence of obesity, high waist circumference, insulin resistance, diabetes, low HDL, hypertension, and metabolic syndrome. Over 3–6 years of follow-up, 33 chronic disease deaths occurred in the sample, representing an estimated 1,084,144 deaths in the U.S. Alongside chronic health conditions, underhydration was a risk factor for an estimated 863,305 deaths. Independent of the chronic health conditions evaluated, underhydration was a risk factor for 128,107 deaths. In weighted multivariable Cox models, underhydration was associated with 4.21 times greater chronic disease mortality (95% CI: 1.29–13.78, p = 0.019). Zero chronic disease deaths were observed for people who met the hydration criteria and did not already have a chronic condition in 2009–2012. Further work should consider effects of underhydration on population health.
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Buoite Stella A, Gaio M, Furlanis G, Ridolfi M, Ajčević M, Sartori A, Caruso P, Morrison SA, Naccarato M, Manganotti P. Prevalence of hypohydration and its association with stroke severity and independence outcomes in acute ischemic stroke patients. J Clin Neurosci 2019; 72:281-286. [PMID: 31837924 DOI: 10.1016/j.jocn.2019.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/15/2019] [Accepted: 11/09/2019] [Indexed: 11/29/2022]
Abstract
Hypohydration has been suggested increasing the risk of vascular diseases, and it is associated with poor prognosis and worse functional outcome in stroke. Most studies have used blood parameters to determine patients' hydration status. The aim of this study was to measure urine osmolality (uOsm) and its influence on stroke severity and independence. A prospective descriptive study was conducted in stroke patients admitted to a stroke unit. All patients underwent neurological evaluation at admission and discharge using the National Institute of Health Stroke Scale (NIHSS). Independence at discharge was evaluated with the Barthel Index (BI) and the modified Rankin Scale (mRS). uOsm was measured at admission. Patients were grouped in "poor fluid intake" (PF) and "euhydration" (EU), the latter if uOsm ≤ 500 mOsm/kg. Among 119 included patients, the prevalence of PF was 52%, with no difference observed between groups in demographics or blood samples analyses. PF had higher chances of NIHSS > 8 at admission (OR: 4.7 95% CI: 1.3-17.0; p = 0.02), lower BI at discharge (β: -15.3 95% CI: -26.7 to -3.8; p = 0.01), and worse mRS at discharge (OR: 4.01 95% CI: 1.2-14.0; p = 0.02). These findings are consistent with previous results, suggesting that uOsm may be a factor significantly associated with stroke severity and independence outcome after acute ischemic stroke.
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Affiliation(s)
- Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy.
| | - Marina Gaio
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Mariana Ridolfi
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Miloš Ajčević
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Arianna Sartori
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Paola Caruso
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Shawnda A Morrison
- Department of Kinesiology and Physiotherapy, Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Marcello Naccarato
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
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Favilla CG, Forti RM, Zamzam A, Detre JA, Mullen MT, Yodh AG, Kasner SE, Busch DR, Baker WB, Mesquita RC, Kung D, Messé SR. Perfusion Enhancement with Respiratory Impedance After Stroke (PERI-Stroke). Neurotherapeutics 2019; 16:1296-1303. [PMID: 31140115 PMCID: PMC6985403 DOI: 10.1007/s13311-019-00744-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Intrathoracic pressure influences cardiac output and may affect cerebral blood flow (CBF). We aimed to quantify the cerebral hemodynamic response to intrathoracic pressure reduction in patients with acute ischemic stroke using a noninvasive respiratory impedance (RI) device. We assessed low-level (6 cm H2O) and high-level (12 cm H2O) RI in 17 spontaneously breathing patients within 72 h of anterior circulation acute ischemic stroke. Average age was 65 years, and 35% were female. Frontal lobe tissue perfusion and middle cerebral artery velocity (MCAv) were continuously monitored with optical diffuse correlation spectroscopy (DCS) and transcranial Doppler ultrasound, respectively. High-level RI resulted in a 7% increase in MCAv (p = 0.004). MCAv varied across all studied levels (baseline vs low-level vs high-level, p = 0.006), with a significant test of trend (p = 0.002). Changes were not seen in DCS measured tissue perfusion by nonparametric pairwise comparison. Mixed effects regression analysis identified a small increase in both MCAv (low-level RI: β 2.1, p < 0.001; high-level RI: β 5.0, p < 0.001) and tissue-level flow (low-level RI: β 5.4, p < 0.001; high-level RI: β 5.9, p < 0.001). There was a small increase in mean arterial pressure during low-level and high-level RI, 4% (p = 0.013) and 4% (p = 0.017), respectively. End-tidal CO2 remained stable throughout the protocol. RI was well tolerated. Manipulating intrathoracic pressure via noninvasive RI was safe and produced a small but measurable increase in cerebral perfusion in acute ischemic stroke patients. Future studies are warranted to assess whether RI is feasible and tolerable for prolonged use in hyperacute stroke management.
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Affiliation(s)
- Christopher G Favilla
- Department of Neurology, University of Pennsylvania, Philadelphia, USA.
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce St, 3 West Gates, Philadelphia, PA, 19104-4283, USA.
| | - Rodrigo M Forti
- Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, USA
- Institute of Physics, University of Campinas, Campinas, 13083-859, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, 13083-888, Brazil
| | - Ahmad Zamzam
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | - John A Detre
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Michael T Mullen
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | - Arjun G Yodh
- Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, USA
| | - Scott E Kasner
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | - David R Busch
- Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, USA
- Department of Anesthesiology & Pain Management, University of Texas Southwestern, Dallas, USA
- Department Neurology & Neurotherapeutics, University of Texas Southwestern, Dallas, USA
| | - Wesley B Baker
- Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, USA
- Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Rickson C Mesquita
- Institute of Physics, University of Campinas, Campinas, 13083-859, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, 13083-888, Brazil
| | - David Kung
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, USA
| | - Steven R Messé
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
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Lacey J, Corbett J, Forni L, Hooper L, Hughes F, Minto G, Moss C, Price S, Whyte G, Woodcock T, Mythen M, Montgomery H. A multidisciplinary consensus on dehydration: definitions, diagnostic methods and clinical implications. Ann Med 2019; 51:232-251. [PMID: 31204514 PMCID: PMC7877883 DOI: 10.1080/07853890.2019.1628352] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/28/2019] [Accepted: 05/28/2019] [Indexed: 01/02/2023] Open
Abstract
Background: Dehydration appears prevalent, costly and associated with adverse outcomes. We sought to generate consensus on such key issues and elucidate need for further scientific enquiry. Materials and methods: A modified Delphi process combined expert opinion and evidence appraisal. Twelve relevant experts addressed dehydration's definition, objective markers and impact on physiology and outcome. Results: Fifteen consensus statements and seven research recommendations were generated. Key findings, evidenced in detail, were that there is no universally accepted definition for dehydration; hydration assessment is complex and requires combining physiological and laboratory variables; "dehydration" and "hypovolaemia" are incorrectly used interchangeably; abnormal hydration status includes relative and/or absolute abnormalities in body water and serum/plasma osmolality (pOsm); raised pOsm usually indicates dehydration; direct measurement of pOsm is the gold standard for determining dehydration; pOsm >300 and ≤280 mOsm/kg classifies a person as hyper or hypo-osmolar; outside extremes, signs of adult dehydration are subtle and unreliable; dehydration is common in hospitals and care homes and associated with poorer outcomes. Discussion: Dehydration poses risk to public health. Dehydration is under-recognized and poorly managed in hospital and community-based care. Further research is required to improve assessment and management of dehydration and the authors have made recommendations to focus academic endeavours. Key messages Dehydration assessment is a major clinical challenge due to a complex, varying pathophysiology, non-specific clinical presentations and the lack of international consensus on definition and diagnosis. Plasma osmolality represents a valuable, objective surrogate marker of hypertonic dehydration which is underutilized in clinical practice. Dehydration is prevalent within the healthcare setting and in the community, and appears associated with increased morbidity and mortality.
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Affiliation(s)
- Jonathan Lacey
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Jo Corbett
- Department of Sport & Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Lui Forni
- Intensive Care Unit, Royal Surrey County Hospital, Guildford, UK
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Fintan Hughes
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Gary Minto
- Department of Anaesthesia, University Hospitals Plymouth, Plymouth, UK
- Peninsula School of Medicine, Plymouth, UK
| | - Charlotte Moss
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Susanna Price
- Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Greg Whyte
- Research Institute for Sport & Exercise Science, Liverpool John Moores University, UK
| | - Tom Woodcock
- Formerly Consultant University Hospitals Southampton NHS Trust, Southampton, UK
| | - Michael Mythen
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Hugh Montgomery
- Centre for Human Health and Performance, University College London, London, UK
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Cortés-Vicente E, Guisado-Alonso D, Delgado-Mederos R, Camps-Renom P, Prats-Sánchez L, Martínez-Domeño A, Martí-Fàbregas J. Frequency, Risk Factors, and Prognosis of Dehydration in Acute Stroke. Front Neurol 2019; 10:305. [PMID: 30984104 PMCID: PMC6450136 DOI: 10.3389/fneur.2019.00305] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/11/2019] [Indexed: 12/28/2022] Open
Abstract
Objective: To determine the frequency, risk factors, and impact on the outcome of dehydration after stroke. Methods: In this cross-sectional observational study, we included prospectively and consecutively patients with ischemic and hemorrhagic stroke. The serum Urea/Creatinine ratio (U/C) was calculated at admission and 3 days after the stroke. Dehydration was defined as U/C>80. Patients were treated in accordance with the standard local hydration protocol. Demographic and clinical data were collected. Neurological severity was evaluated at admission according to the NIHSS score; functional outcome was assessed with the modified Rankin scale score (mRS) at discharge and 3 months after the stroke. Unfavorable outcome was defined as mRS > 2. Results: We evaluated 203 patients; 78.8% presented an ischemic stroke and 21.2% a hemorrhagic stroke. The mean age was 73.4 years ±12.9; 51.7% were men. Dehydration was detected in 18 patients (8.9%), nine patients at admission (4.5%), and nine patients (4.5%) at 3 days after the stroke. Female sex (OR 3.62, 95%CI 1.13-11.58, p = 0.03) and older age (OR 1.05, 95%CI 1-1.11, p = 0.048) were associated with a higher risk of dehydration. Dehydration was significantly associated with an unfavorable outcome at discharge (OR 5.16, 95%CI 1.45-18.25, p = 0.011), but the association was not significant at 3 months (OR 2.95, 95%CI 0.83-10.48, p = 0.095). Conclusion: Dehydration is a treatable risk factor of a poor functional outcome after stroke that is present in 9% of patients. Females and elders present a higher risk of dehydration.
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Affiliation(s)
- Elena Cortés-Vicente
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Daniel Guisado-Alonso
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Raquel Delgado-Mederos
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pol Camps-Renom
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luis Prats-Sánchez
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Martínez-Domeño
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Martí-Fàbregas
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
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Bunn DK, Hooper L. Signs and Symptoms of Low-Intake Dehydration Do Not Work in Older Care Home Residents-DRIE Diagnostic Accuracy Study. J Am Med Dir Assoc 2019; 20:963-970. [PMID: 30872081 DOI: 10.1016/j.jamda.2019.01.122] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/04/2019] [Accepted: 01/05/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To assess the diagnostic accuracy of commonly used signs and symptoms of low-intake dehydration in older care home residents. DESIGN Prospective diagnostic accuracy study. SETTING 56 care homes offering residential, nursing, and/or dementia care to older adults in Norfolk and Suffolk, United Kingdom. PARTICIPANTS 188 consecutively recruited care home residents aged ≥65 years, without cardiac or renal failure and not receiving palliative care. Overall, 66% were female, the mean age was 85.7 years (standard deviation 7.8), and the median Mini-Mental State Examination MMSE score was 23 (interquartile range 18-26). INDEX TESTS Over 2 hours, participants underwent double-blind assessment of 49 signs and symptoms of dehydration and measurement of serum osmolality from a venous blood sample. Signs and symptoms included skin turgor; mouth, skin, and axillary dryness; capillary refill; sunken eyes; blood pressure on resting and after standing; body temperature; pulse rate; and self-reported feelings of thirst and well-being. REFERENCE STANDARD Serum osmolality, with current dehydration defined as >300 mOsm/kg, and impending dehydration ≥295 mOsm/kg. OUTCOME MEASURES For dichotomous tests, we aimed for sensitivity and specificity >70%, and for continuous tests, an area under the curve in receiver operating characteristic plots of >0.7. RESULTS Although 20% of residents had current low-intake dehydration and a further 28% impending dehydration, none of the commonly used clinical signs and symptoms usefully discriminated between participants with or without low-intake dehydration at either cut-off. CONCLUSIONS/IMPLICATIONS This study consolidates evidence that commonly used signs and symptoms of dehydration lack even basic levels of diagnostic accuracy in older adults, implying that many who are dehydrated are not being identified, thus compromising their health and well-being. We suggest that these tests be withdrawn from practice and replaced with a 2-stage screening process that includes serum osmolarity, calculated from sodium, potassium, urea, and glucose levels (assessed routinely using the Khajuria and Krahn equation), followed by serum osmolality measurement for those identified as high risk (calculated serum osmolarity >295 mmol/L).
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Affiliation(s)
- Diane K Bunn
- School of Health Sciences, Norwich Research Park, University of East Anglia, Norwich, Norfolk, England, United Kingdom.
| | - Lee Hooper
- Norwich Medical School, Norwich Research Park, University of East Anglia, Norwich, Norfolk, England, United Kingdom
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Farhan S, Vogel B, Baber U, Sartori S, Aquino M, Chandrasekhar J, Sorrentino S, Giustino G, Sharma M, Guedeney P, Rohla M, Bhandari R, Barman N, Sweeny J, Dangas G, Mehran R, Kini A, Sharma S. Calculated Serum Osmolality, Acute Kidney Injury, and Relationship to Mortality after Percutaneous Coronary Intervention. Cardiorenal Med 2019; 9:160-167. [PMID: 30844810 DOI: 10.1159/000494807] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/22/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Data on the associations between serum osmolality (sOsmo) and acute kidney injury (AKI) as well as short- and long-term mortality in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) are limited. OBJECTIVES To investigate the association between sOsmo and development of AKI and clinical outcomes in patients undergoing PCI. METHODS We investigated 1,927 consecutive patients undergoing PCI from the registry of a single center. Patients were divided into quartiles according to sOsmo at admission (Q1-Q4). sOsmo was calculated using the following equation: (1.86 × serum sodium [mmol/L]) + (glucose [mg/dL] / 18) + (blood urea nitrogen [mg/dL] / 2.8) + 9. The primary endpoint was AKI, per Kidney Disease: Improving Global Outcomes (KDIGO) definition. The secondary endpoints were 30-day and 1-year all-cause mortality. RESULTS Patients with the highest sOsmo (Q4) were older and more likely female, with significantly more cardiovascular risk factors and comorbidities compared to those with lower sOsmo (Q1-Q3). Incidence of AKI was highest in Q4 and lowest in Q2. In the multivariate logistic regression model, high sOsmo independently predicted the development of AKI (OR 2.00, 95% CI 1.26-3.19, p = 0.003). Patients with Q4 had a higher risk of 1-year mortality compared to patients with Q2 (HR 2.11, 95% CI 1.10-4.15; p = 0.031), but not after adding AKI to the multivariate model (HR 1.71, 95% CI 0.87-3.39; p = 0.12). CONCLUSION sOsmo is a valid and easily obtainable predictor of AKI after PCI. High sOsmo is associated with increased risk of AKI and 1-year mortality in patients undergoing PCI. Further research is warranted to clarify whether the use of an sOsmo-directed hydration protocol might reduce the incidence of AKI in patients undergoing PCI.
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Affiliation(s)
- Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Third Department of Medicine, Cardiology, and Intensive Care Medicine, Wilhelminen Hospital Vienna, Vienna, Austria
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Melissa Aquino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jaya Chandrasekhar
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sabato Sorrentino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Madhav Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Paul Guedeney
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Miklos Rohla
- Third Department of Medicine, Cardiology, and Intensive Care Medicine, Wilhelminen Hospital Vienna, Vienna, Austria
| | - Reyna Bhandari
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nitin Barman
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joseph Sweeny
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samin Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA,
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Jimoh OF, Brown TJ, Bunn D, Hooper L. Beverage Intake and Drinking Patterns-Clues to Support Older People Living in Long-Term Care to Drink Well: DRIE and FISE Studies. Nutrients 2019; 11:E447. [PMID: 30795521 PMCID: PMC6412353 DOI: 10.3390/nu11020447] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/06/2019] [Accepted: 02/16/2019] [Indexed: 11/16/2022] Open
Abstract
Low-intake dehydration, due to insufficient beverage intake, is common in older people and associated with increased mortality and morbidity. We aimed to document the drinking patterns of older adults living in long-term care and compared patterns in those drinking well with those not drinking enough. One-hundred-and-eighty-eight people aged ≥ 65 years living in 56 UK long-term care homes were interviewed and hydration status was assessed in the Dehydration Recognition In our Elders (DRIE) study. In 22 DRIE residents, the Fluid Intake Study in our Elders (FISE) directly observed, weighed and recorded all drinks intake over 24 h. Twenty percent of DRIE participants and 18% of FISE participants had low-intake dehydration (serum osmolality > 300 mOsm/kg). Mean total drinks intake was 1787 mL/day (SD 693) in FISE participants (2033 ± 842 mL/day in men; 1748 ± 684 mL/day in women). Most drinks intake was between meals (59%, including 10% with medications). Twelve (55%) FISE participants achieved European Food Safety Authority drinks goals (3/6 men drank ≥ 2.0 L/day, 9/16 women drank ≥ 1.6 L/day). Those drinking well were offered beverages more frequently and drank more with medications and before breakfast (beverage variety did not differ). Promising strategies to support healthy drinking include offering drinks more frequently, particularly before and during breakfast and with medication.
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Affiliation(s)
- Oluseyi F Jimoh
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
| | - Tracey J Brown
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
| | - Diane Bunn
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
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Tan Timur U, Caron M, van den Akker G, van der Windt A, Visser J, van Rhijn L, Weinans H, Welting T, Emans P, Jahr H. Increased TGF-β and BMP Levels and Improved Chondrocyte-Specific Marker Expression In Vitro under Cartilage-Specific Physiological Osmolarity. Int J Mol Sci 2019; 20:ijms20040795. [PMID: 30781744 PMCID: PMC6412363 DOI: 10.3390/ijms20040795] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 01/31/2019] [Accepted: 02/07/2019] [Indexed: 11/16/2022] Open
Abstract
During standard expansion culture (i.e., plasma osmolarity, 280 mOsm) human articular chondrocytes dedifferentiate, making them inappropriate for autologous chondrocyte implantation to treat cartilage defects. Increasing the osmolarity of culture media to physiological osmolarity levels of cartilage (i.e., 380 mOsm), increases collagen type II (COL2A1) expression of human articular chondrocytes in vitro, but the underlying molecular mechanism is not fully understood. We hypothesized that TGF-β superfamily signaling may drive expression of COL2A1 under physiological osmolarity culture conditions. Human articular chondrocytes were cultured in cytokine-free medium of 280 or 380 mOsm with or without siRNA mediated TGF-β2 knockdown (RNAi). Expression of TGF-β isoforms, and collagen type II was evaluated by RT-qPCR and immunoblotting. TGF-β2 protein secretion was evaluated using ELISA and TGF-β bioactivity was determined using an established reporter assay. Involvement of BMP signaling was investigated by culturing human articular chondrocytes in the presence or absence of BMP inhibitor dorsomorphin and BMP bioactivity was determined using an established reporter assay. Physiological cartilage osmolarity (i.e., physosmolarity) most prominently increased TGF-β2 mRNA expression and protein secretion as well as TGF-β bioactivity. Upon TGF-β2 isoform-specific knockdown, gene expression of chondrocyte marker COL2A1 was induced. TGF-β2 RNAi under physosmolarity enhanced TGF-β bioactivity. BMP bioactivity increased upon physosmotic treatment, but was not related to TGF-β2 RNAi. In contrast, dorsomorphin inhibited COL2A1 mRNA expression in human articular chondrocytes independent of the osmotic condition. Our data suggest a role for TGF-β superfamily member signaling in physosmolarity-induced mRNA expression of collagen type II. As physosmotic conditions favor the expression of COL2A1 independent of our manipulations, contribution of other metabolic, post-transcriptional or epigenetic factors cannot be excluded in the underlying complex and interdependent regulation of marker gene expression. Dissecting these molecular mechanisms holds potential to further improve future cell-based chondral repair strategies.
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Affiliation(s)
- Ufuk Tan Timur
- Laboratory for Experimental Orthopedics, Department of Orthopaedic Surgery, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands.
- Institute of Anatomy and Cell Biology, RWTH Aachen University, 52074 Aachen, Germany..
| | - Marjolein Caron
- Laboratory for Experimental Orthopedics, Department of Orthopaedic Surgery, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands.
| | - Guus van den Akker
- Laboratory for Experimental Orthopedics, Department of Orthopaedic Surgery, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands.
| | - Anna van der Windt
- Department of Orthopaedics, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
| | - Jenny Visser
- Department of Internal Medicine, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands.
| | - Lodewijk van Rhijn
- Laboratory for Experimental Orthopedics, Department of Orthopaedic Surgery, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands.
| | - Harrie Weinans
- Department of Orthopaedics, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands.
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands.
- Department of Biomechanical Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands.
| | - Tim Welting
- Laboratory for Experimental Orthopedics, Department of Orthopaedic Surgery, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands.
| | - Pieter Emans
- Laboratory for Experimental Orthopedics, Department of Orthopaedic Surgery, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands.
| | - Holger Jahr
- Laboratory for Experimental Orthopedics, Department of Orthopaedic Surgery, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands.
- Institute of Anatomy and Cell Biology, RWTH Aachen University, 52074 Aachen, Germany..
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Liu K, Pei L, Gao Y, Zhao L, Fang H, Bunda B, Fisher L, Wang Y, Li S, Li Y, Guan S, Guo X, Xu H, Xu Y, Song B. Dehydration Status Predicts Short-Term and Long-Term Outcomes in Patients with Cerebral Venous Thrombosis. Neurocrit Care 2018; 30:478-483. [DOI: 10.1007/s12028-018-0628-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Billington CK, Appleton JP, Berge E, Sprigg N, Glover M, Bath PMW. Impact of hydration status on haemodynamics, effects of acute blood pressure-lowering treatment, and prognosis after stroke. Br J Clin Pharmacol 2018; 84:2914-2922. [PMID: 30194849 PMCID: PMC6256053 DOI: 10.1111/bcp.13761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/22/2018] [Accepted: 08/28/2018] [Indexed: 11/17/2022] Open
Abstract
Aims Although high blood pressure (BP) is common in acute stroke and associated with poor outcome, the Efficacy of Nitric Oxide in Stroke (ENOS) trial showed no beneficial effect of antihypertensive treatment in this situation. Antihypertensive agents have accentuated effects in dehydrated patients. We assessed the impact of dehydration on haemodynamics, the effects of antihypertensive treatment, and prognosis in the ENOS trial. Methods ENOS randomized 4011 patients with acute stroke and raised systolic BP to a glyceryl trinitrate (GTN) patch or no GTN patch, and to continue or to stop existing antihypertensive treatment within 48 h of onset. The primary outcome was functional outcome (modified Rankin Scale, mRS) at day 90. Blood markers of dehydration at baseline were collected at two sites (n = 310) and their relationship with haemodynamics and outcome was assessed. Results There were no significant associations between dehydration markers and fall in blood pressure from baseline to day 1, and no significant interaction with allocated treatment. Overall, increasing urea was associated with an unfavourable shift in mRS [odds ratio 3.43, 95% confidence interval (CI) 1.42, 8.32; P = 0.006] and increased risk of death at day 90 (hazard ratio 4.55, 95% CI 1.51, 13.66; P = 0.007). Conclusions Blood pressure‐lowering treatment was safe in dehydrated patients, with no precipitous changes in BP, thus supporting its use in acute stroke prior to blood markers of dehydration becoming available. Increased baseline urea was associated with poor prognosis after stroke.
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Affiliation(s)
| | - Jason P Appleton
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Eivind Berge
- Department of Internal Medicine and Cardiology, Oslo University Hospital, Oslo, Norway
| | - Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Mark Glover
- Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
| | - Philip M W Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
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Tsai YH, Yang JL, Lee IN, Yang JT, Lin LC, Huang YC, Yeh MY, Weng HH, Su CH. Effects of Dehydration on Brain Perfusion and Infarct Core After Acute Middle Cerebral Artery Occlusion in Rats: Evidence From High-Field Magnetic Resonance Imaging. Front Neurol 2018; 9:786. [PMID: 30294297 PMCID: PMC6158308 DOI: 10.3389/fneur.2018.00786] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/30/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Dehydration is common among ischemic stroke patients and is associated with early neurological deterioration and poor outcome. This study aimed to test the hypothesis that dehydration status is associated with decreased cerebral perfusion and aggravation of ischemic brain injury. Methods: Diffusion-weighted imaging and arterial spin labeling perfusion MR imaging were performed on rats with middle cerebral artery occlusion (MCAO) by using a 9.4T MR imaging scanner to measure the volume of infarction and relative cerebral blood flow (rCBF) after infarction. Twenty-five rats were assigned to either a dehydration group or normal hydration group, and dehydration status was achieved by water deprivation for 48 h prior to MCAO. Results: The volume of the infarction was significantly larger for the dehydration group at the 4th h after MCAO (p = 0.040). The progression in the infarct volume between the 1st and 4th h was also larger in the dehydration group (p = 0.021). The average rCBF values of the contralateral normal hemispheres at the 1st and the 4th h were significantly lower in the dehydration group (p = 0.027 and 0.040, respectively). Conclusions: Our findings suggested that dehydration status is associated with the progression of infarct volume and decreases in cerebral blood flow during the acute stage of ischemic stroke. This preliminary study provided an imaging clue that more intensive hydration therapies and reperfusion strategies are necessary for the management of acute ischemic stroke patients with dehydration status.
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Affiliation(s)
- Yuan-Hsiung Tsai
- Departments of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jenq-Lin Yang
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - I-Neng Lee
- Department of Medical Research, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Jen-Tsung Yang
- Department of Neurosurgery Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Leng-Chieh Lin
- Department of Emergency Medicine Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Chu Huang
- Department of Neurology, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Mei-Yu Yeh
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Hsu-Huei Weng
- Departments of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hao Su
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Koç Ş, Baysal S, Koç Z, Yener AÜ. Detection of Glycemia and Osmolarity Changes Using Eye Examinations. Metab Syndr Relat Disord 2018; 16:543-550. [PMID: 30183500 DOI: 10.1089/met.2018.0076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Glycated hemoglobin (HbA1c) is an index of the average blood glucose level over the preceding 2-3 months. In experimental studies, the lens responded to changes in osmolarity by forming vacuoles. By observing the vacuoles of the lens during eye examination, can we detect changes in osmolarity and glycemia over the last 6 months through HbA1c levels? Methods: In total, 400 patients (mean age, 67.7 ± 9.8 years), including those with diabetes mellitus, hypertension, and heart failure, were included in the study. The control group contained 70 patients matched in terms of age and sex and who had no prior disease (mean age, 67.8 ± 9.4 years). Monthly Na, glucose, and blood urea nitrogen values were used to calculate changes in osmolarity over 6 months. HbA1c values were also recorded. Biomicroscopy was used to evaluate lens vacuolation; all vacuoles were digitally photographed and converted to ImageJ format. Results: The sensitivity and specificity of using large vacuoles to detect HbA1c ≥10% were 88.0% (95% confidence interval [CI]: 68.8-97.4) and 82.6% (95% CI: 74.1-89.2), respectively. The sensitivity and specificity of detecting a 10 mOsm/kg change in osmolarity were 61% (95% CI: 48.9-72.4) and 94.5% (95% CI: 91.5-96.7), respectively. Conclusions: Lens vacuoles, which can be observed with a simple and quick examination, can be used to detect HbA1c levels and osmolarity changes over the last 6 months. Because of their relationship to the severity of retinopathy, vacuoles can also be used as a weak control indicator.
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Affiliation(s)
- Şahbender Koç
- Department of Cardiology and Keçiören Education and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Selçuk Baysal
- Department of Cardiology, Urfa Education and Training Hospital, University of Health Sciences, Urfa, Turkey
| | - Zuhal Koç
- Department of Internal Medicine, Onkoloji Education and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Arif Ülkü Yener
- Department of Ophthalmology, Keçiören Education and Training Hospital, University of Health Sciences, Ankara, Turkey
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Lin J, Jiang A, Ling M, Mo Y, Li M, Zhao J. Prediction of neurologic deterioration based on support vector machine algorithms and serum osmolarity equations. Brain Behav 2018; 8:e01023. [PMID: 29888877 PMCID: PMC6043694 DOI: 10.1002/brb3.1023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 04/22/2018] [Accepted: 04/30/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Dehydration on admission is correlated with neurological deterioration (ND). The primary objective of our study was to use support vector machine (SVM) algorithms to identify an ND prognostic model, based on dehydration equations. METHODS This study included a total of 382 patients hospitalized with acute ischemic stroke. The following parameters were recorded: age, sex, laboratory values (serum sodium, potassium, chlorinum, glucose, and urea), and vascular risk factor data. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminative performance of the BUN/Cr ratio as well as each of 38 equations for predicting ND. We used the Boruta algorithm for feature selection. After optimizing the SVM kernel parameters, we built an SVM model to predict ND and used the test set to obtain predictive values for assessing model accuracy. RESULTS In total, 102 of 382 patients (26.7%) with acute ischemic stroke developed ND. In all patients, the BUN/Cr ratio and each of 38 equations were significant predictors of ND. Equation 20 [1.86 × Na+ + glucose + urea + 9] yielded the maximum area under the ROC curve, and faired best in terms of prognostic performance (a cutoff value of 284.49 mM yielded a sensitivity of 94.12% and specificity of 61.43%). Equation 32 predicted ND poststroke across population groups, and worked well in older as well as young adults; (a cutoff value of 297.08 mM yielded a sensitivity of 93.14% and specificity of 60.00%). Feature selection by the Boruta algorithm was used to decrease the number of variables from 18 to 5 in the condition. The specificity of test samples for the SVM prediction model increased from 44.1% to 89.4%, and the AUC increased from 0.700 to 0.927. CONCLUSIONS SVM algorithms can be used to establish a prediction model for dehydration-associated ND, with good classification results.
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Affiliation(s)
- Jixian Lin
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Aihua Jiang
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Meirong Ling
- Emergency Department, Minhang Hospital, Fudan University, Shanghai, China
| | - Yanqing Mo
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China.,Institute of Fudan-Minhang Academic Health System, Minhang Hospital, Fudan University, Shanghai, China
| | - Meiyi Li
- Institute of Fudan-Minhang Academic Health System, Minhang Hospital, Fudan University, Shanghai, China
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
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50
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ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 2018; 38:10-47. [PMID: 30005900 DOI: 10.1016/j.clnu.2018.05.024] [Citation(s) in RCA: 642] [Impact Index Per Article: 107.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. AIM To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. METHODS This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. RESULTS We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. CONCLUSION A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.
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