Early Hyperchloremia and Outcomes After Acute Ischemic Stroke |
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| Affiliation: | 1. Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, One Hospital Dr. CE507, Columbia, MO, USA;2. Department of Neurology, University of Missouri, Columbia, MO, USA;3. Department of Nephrology, University of Missouri, Columbia, MO, USA;4. Division of Neurosurgery, University of Missouri, Columbia, MO, USA;5. Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA;1. Stroke Unit. Department of Neurology. Hospital UniversitarI Doctor Josep Trueta de Girona. Girona Biomedical Research Institute (IDIBGI). Girona, Spain;2. Statistical and Methodological Advisory Unit, Girona Biomedical Research Institute (IDIBGI), Girona, Spain;3. Cerebrovascular Pathology Research Group, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Girona, Spain;1. Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA;2. School of Medicine, Stony Brook University, Stony Brook, NY, USA;1. Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119, the South Fourth Ring West Road, Fengtai district, Beijing 100070, China;2. Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing 100070, China;3. The George Institute for Global Health at Peking University Health Science Center, Beijing, China;4. Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia;5. Department of Ultrasound, Huaian Hospital of Huaian City, Huaian, Jiangsu, China;1. Department of Rehabilitation Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, 1197-1 Yasashicho, Asahi-ku, Yokohama, Kanagawa 241-0811, Japan;2. Faculty of Medical Science, Shonan University of Medical Sciences, 16-48, Kamishinano, Totsuka-ku, Yokohama, Kanagawa 244-0806, Japan;3. Department of Rehabilitation Medicine, Sakuragaoka Central Hospital, 1-7-1 Fukuda, Yamato, Kanagawa 242-0024, Japan;4. Department of Neurosurgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital, 1197-1 Yasashicho, Asahi-ku, Yokohama, Kanagawa 241-0811, Japan;1. Department of Neurology, University of Miami Miller School of Medicine, Miami, FL;2. Department of Neurology, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY;3. Department of Epidemiology, Mailman School of Public Health, and Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY;4. Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL;1. Columbia University Irving Medical Center, New York, United States;2. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, United States;3. Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands;4. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Harvard University, United States;5. World Without Disease Accelerator (WWDA), The Janssen Pharmaceutical Companies of Johnson & Johnson, Leiden, the Netherlands and Leyden Laboratories, Leiden, the Netherlands;6. Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands;7. Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, United States |
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| Abstract: | ObjectiveBased on the relationship between hyperchloremia and mortality in critically ill patients, we investigated the effect of early hyperchloremia on 90-day outcomes in acute ischemic stroke patients.Materials and MethodsAcute ischemic stroke patients recruited within 5 h of symptom onset were analyzed. Hyperchloremia (defined as 110 mmol/L or greater) at either baseline, or 24, or 48 h after randomization was identified and classified as one occurrence or two or more occurrences. Logistic regression analyses were performed to determine the effects of hyperchloremia on: favorable outcomes (defined by a National Institutes of Health Stroke Scale and/or modified Rankin scale scores of 0-1) at 90-day, death or disability at 90-day, and death within 90-day after accounting for potential confounders.ResultsAmong the total of 1275 patients, one and two or more occurrence of hyperchloremia within 48 h were seen in 191 patients and 108 patients, respectively. Compared with patients without hyperchloremia, patients with two or more occurrences of hyperchloremia at significantly higher odds of lack of favorable outcomes (odds ratio 3.0, 95% confidence interval 1.8-5.1) and death or disability (odds ratio 2.6, 95% confidence interval 1.6-4.1) at 90-day after adjustment for age, National Institutes of Health Stroke Scale score strata (6-9, 10-19, ≥ 20), study intervention, initial SBP, and intra-arterial treatment.ConclusionsThe independent association between sustained hyperchloremia and lack of favorable outcomes at 90-day suggest that avoidance of hyperchloremia may reduce the rate of lack of favorable outcomes and death or disability in patients with acute ischemic stroke. |
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