title: Favorable outcome of blood urea nitrogen/creatinine-based hydration therapy 3 months after acute ischemic stroke.
abstract: BACKGROUND
  Dehydration is associated with acute ischemic stroke. However, the relationship between hydration therapy given during acute ischemic stroke and clinical outcomes remains unclear.
  
  
  OBJECTIVE
  We determined whether hydration therapy in patients with a blood urea nitrogen/creatinine (BUN/Cr) ratio of at least 15 improved clinical outcome.
  
  
  METHODS
  We conducted a nonblinded, phase II, single-arm, prospective study of patients with acute ischemic stroke and BUN/Cr ratio of at least 15 with historical controls. The hydration group received intravenous bolus (300-500 mL) saline followed by maintenance saline infusion (40-80 mL/h for the first 72 hours), whereas the control group received maintenance saline infusion (40-60 mL/h for the first 24 hours and 0-60 mL/h for 24-72 hours after stroke). The study end point was the percentage of patients with a favorable outcome defined as modified Rankin scale score of 2 or lower at 3 months after stroke.
  
  
  RESULTS
  A total of 237 patients were enrolled (hydration, n = 134; control, n = 103). The mean volume of saline infused within the first 72 hours was significantly larger (P < .001), and the rate of favorable outcome at 3 months after stroke was significantly higher (P = .016) in the hydration group than in the controls. Further analysis revealed that the difference was significant in the lacunar stroke subtype (P = .020) but not in the nonlacunar subtype.
  
  
  CONCLUSIONS
  Blood urea nitrogen/Cr ratio-based saline hydration therapy in patients with acute ischemic stroke significantly increased the rate of favorable clinical outcome with functional independence at 3 months after stroke.
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan. Electronic address: cyprus90210@gmail.com.
authors.forename: Chung Jen
authors.initials: CJ
authors.lastname: Lin
authors.affiliation: Division of Neurosurgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Puzih City, Chiayi County, Taiwan. Electronic address: jents716@ms32.hinet.net.
authors.forename: Jen Tsung
authors.initials: JT
authors.lastname: Yang
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan; Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan. Electronic address: deepblue@cgmh.org.tw.
authors.forename: Yen Chu
authors.initials: YC
authors.lastname: Huang
authors.affiliation: Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan; Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan. Electronic address: russell@cgmh.org.tw.
authors.forename: Yuan Hsiung
authors.initials: YH
authors.lastname: Tsai
authors.affiliation: Division of Neurosurgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Puzih City, Chiayi County, Taiwan; Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan. Electronic address: ma2072@gmail.com.
authors.forename: Ming Hsueh
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan; Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan. Electronic address: menglee5126@gmail.com.
authors.forename: Meng
authors.initials: M
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan; Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan. Electronic address: qcth3160@cgmh.org.tw.
authors.forename: Cheng Ting
authors.initials: CT
authors.lastname: Hsiao
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan; Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan. Electronic address: richard_smith@mail2000.com.tw.
authors.forename: Kuang Yu
authors.initials: KY
authors.lastname: Hsiao
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County, Taiwan; Departments of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan. Electronic address: a3456711@ms65.hinet.net.
authors.forename: Leng Chieh
authors.initials: LC
authors.lastname: Lin
mesh_terms: D000368:Aged; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood*; D003681:Dehydration / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015532:Rehydration Solutions / Q000008:administration & dosage*; D012965:Sodium Chloride / Q000008:administration & dosage*; D020521:Stroke / Q000150:complications*; D013624:Taiwan; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D015532:Rehydration Solutions; D012965:Sodium Chloride; D003404:Creatinine; D010959:Tissue Plasminogen Activator