Dehydration is an independent predictor of discharge outcome and admission cost in acute ischaemic stroke

• Published in: European journal of neurology Vol. 21; no. 9; pp. 1184 - 1191
• Main Authors: Liu, C.-H., Lin, S.-C., Lin, J.-R., Yang, J.-T., Chang, Y.-J., Chang, C.-H., Chang, T.-Y., Huang, K.-L., Ryu, S.-J., Lee, T.-H.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-09-2014; John Wiley & Sons, Inc
• Subjects: acute stroke; Aged; Aged, 80 and over; Brain Ischemia - complications; BUN/Cr; cost; Costs; Costs and Cost Analysis; Dehydration; Female; Hospitalization - economics; Humans; Male; Middle Aged; Multivariate analysis; outcome; Patient Admission - economics; Patient Discharge; Predictive Value of Tests; Registries; Retrospective Studies; Severity of Illness Index; Statistics, Nonparametric; Stroke; Stroke - etiology; Treatment Outcome; BUN/Cr; dehydration; acute stroke; cost; outcome
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/ene.12452

Background and purpose
Our aim was to investigate the influence of admission dehydration on the discharge outcome in acute ischaemic and hemorrhagic stroke.
Methods
Between January 2009 and December 2011, 4311 ischaemic and 1371 hemorrhagic stroke patients from the stroke registry of Chang Gung healthcare system were analyzed. The eligible patients were identified according to inclusion/exclusion criteria. In total, 2570 acute ischaemic and 573 acute hemorrhagic stroke patients were finally recruited. According to the blood urea nitrogen (BUN) to creatinine (Cr) ratio (BUN/Cr), these patients were divided into dehydrated (BUN/Cr ≥ 15) and non‐dehydrated (BUN/Cr < 15) groups. Demographics, admission costs and discharge outcomes including modified Rankin scale (mRS) and Barthel index (BI) were examined. Data were analyzed using multivariate analysis of two‐stage least squares including logistic and linear regression.
Results
Acute ischaemic stroke with admission dehydration had higher infection rates (P = 0.006), worse discharge BI (62.8 ± 37.4 vs. 73.4 ± 32.4, P < 0.001, adjusted P < 0.001), worse mRS (2.7 ± 1.6 vs. 2.3 ± 1.5, P < 0.001, adjusted P = 0.009) and higher admission costs (2470.8 ± 3160.8 vs. 1901.2 ± 2046.8 US dollars, P < 0.001, adjusted P = 0.013) than those without dehydration. However, acute hemorrhagic stroke with or without admission dehydration showd no difference in admission costs (P = 0.618) and discharge outcomes (BI, P = 0.058; mRS, P = 0.058).
Conclusion
Admission dehydration is associated with worse discharge outcomes and higher admission costs in acute ischaemic stroke but not in hemorrhagic stroke.