Preliminary Prospective Study to Assess the Effect of Early Blood Urea Nitrogen/Creatinine Ratio-Based Hydration Therapy on Poststroke Infection Rate and Length of Stay in Acute Ischemic Stroke.
BACKGROUND
This study aimed to determine whether blood urea nitrogen (BUN)/creatinine (Cr)-based hydration therapy can decrease the rate of poststroke infection and length of stay (LOS) in the neurology ward.


METHODS
This was a nonblinded, phase II single-arm prospective study with a historical control group of patients with acute ischemic stroke and a BUN/Cr ratio of 15 or higher. The study group (n = 134) received an intravenous saline bolus (300-500 mL) followed by maintenance saline (40-80 mL/hour) for the first 72 hours. The control group (n = 103) received maintenance saline infusions (40-60 mL/hour for the first 24 hours and 0-60 mL/hour for the next 24-72 hours).


RESULTS
The hydration group had a significantly lower poststroke infection rate than did the control group (7.5% versus 17.5%, P = .018) and significantly shorter LOS in the neurology ward (13.5 ± 11.6 versus 19.6 ± 14.6 days, P < .01). With regard to adverse events, two patients in each group had cerebral edema.


CONCLUSIONS
The findings suggest that the BUN/Cr ratio needs to be corrected in a timely manner in patients with acute ischemic stroke. Providing prompt saline hydration therapy based on the daily BUN/Cr ratio might decrease the poststroke infection rate and shorten LOS.
Department of Emergency Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Chiayi, Taiwan.
Wei-Chun
WC
Lin
Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan.
Hong-Mo
HM
Shih
Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan. Electronic address: a3456711@ms65.hinet.net.
Leng-Chieh
LC
Lin
D000368:Aged; D000369:Aged, 80 and over; D001806:Blood Urea Nitrogen; D002545:Brain Ischemia / Q000097:blood / Q000150:complications / Q000628:therapy*; D003404:Creatinine / Q000097:blood*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology* / Q000517:prevention & control; D011446:Prospective Studies; D020521:Stroke / Q000097:blood / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000209:etiology* / Q000517:prevention & control
D003404:Creatinine
Blood urea nitrogen; acute ischemic stroke; creatinine; dehydration; hydration therapy; infection; length of stay