title: Prescription of anti-oedema agents and short-term mortality in older patients with acute ischaemic stroke.
abstract: OBJECTIVE
  In Western countries, stroke is the third most common cause of death and one of the main causes of disability in individuals aged over 65 years. Mortality at 1 month after stroke is still high, at around 25-30%. Despite the widespread use of anti-oedema agents in clinical practice, there are only a few studies that have investigated the effect of these drugs on stroke outcome. In this study we evaluated the effect of intravenously administered glycerol or mannitol individually and in combination with corticosteroids, on short-term mortality (30 days). The sample included patients aged over 65 years who were admitted to hospital for acute ischaemic stroke.
  
  
  METHODS
  This was a retrospective cohort study. The odds ratio, estimated by means of multivariate logistic regression method, was used to compare short-term mortality risk across treatment groups after adjusting for possible confounders.
  
  
  METHODS
  This study included 442 consecutive patients aged over 65 years with severe ischaemic stroke who were admitted to either the University School of Internal Medicine (Ferrara) or the Geriatric Department (Perugia), Italy, over a 4-year period (1996-2000). All patients underwent a computed tomography (CT) scan of the brain within 72 hours of admission. Stroke type was classified according to the system used by the Oxfordshire Community Stroke Project. The data recorded included: (i) clinical features of stroke; (ii) detailed medical history, including vascular risk factors (arterial hypertension, diabetes mellitus, atrial fibrillation, coronary heart disease, congestive heart failure, alcohol abuse, smoking, previous transient ischaemic attacks or stroke); (iii) 12-lead ECG; and (iv) routine blood analysis and urine tests.
  
  
  RESULTS
  No reduction in short-term mortality risk was observed in patients treated with intravenous (IV) glycerol. However, an increase in short-term mortality risk was observed in the patients who were concurrently treated with IV corticosteroids. Similarly, treatment with mannitol did not reduce the risk of short-term mortality; however, concurrent treatment with IV corticosteroids did not show a significant rise in short-term mortality risk. When treatment with IV glycerol and mannitol was considered together, the treatment did not decrease short-term mortality risk, while concurrent therapy with corticosteroids was associated with an increase in short-term mortality risk.
  
  
  CONCLUSIONS
  This study does not support the use of IV osmotic agents such as glycerol or mannitol in the prevention of short-term mortality in older patients with acute ischaemic stroke. Furthermore, our data suggest a possible harmful effect of IV corticosteroids on short-term mortality risk.
authors.affiliation: 2nd Department of Internal Medicine, University of Ferrara, Ferrara, Italy. gzuliani@hotmail.com
authors.forename: Giovanni
authors.initials: G
authors.lastname: Zuliani
authors.forename: Antonio
authors.initials: A
authors.lastname: Cherubini
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Atti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ble
authors.forename: Chella
authors.initials: C
authors.lastname: Vavalle
authors.forename: Filippo
authors.initials: F
authors.lastname: Di Todaro
authors.forename: Claudia
authors.initials: C
authors.lastname: Benedetti
authors.forename: Stefano
authors.initials: S
authors.lastname: Volpato
authors.forename: Maria
authors.initials: M
authors.lastname: Grazia Marinescu
authors.forename: Fabio
authors.initials: F
authors.lastname: Schena
authors.forename: Umberto
authors.initials: U
authors.lastname: Senin
authors.forename: Renato
authors.initials: R
authors.lastname: Fellin
mesh_terms: D000368:Aged; D001929:Brain Edema / Q000188:drug therapy* / Q000209:etiology; D015331:Cohort Studies; D004234:Diuretics, Osmotic / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D005990:Glycerol / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008353:Mannitol / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000188:drug therapy* / Q000401:mortality
chemical_list: D004234:Diuretics, Osmotic; D005938:Glucocorticoids; D008353:Mannitol; D005990:Glycerol