Schrock Jon W, Glasenapp Michael, Drogell Kristin
MetroHealth Medical Center, Department of Emergency Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44109-1998, United States.
Clin Neurol Neurosurg. 2012 Sep;114(7):881-4. doi: 10.1016/j.clineuro.2012.01.031. Epub 2012 Feb 12.
Dehydration may impair cerebral oxygen delivery and worsen clinical outcome in patients with acute ischemic stroke (AIS). We evaluated if elevated blood urea nitrogen to creatinine ratio (BUN/Cr) as a marker of dehydration was associated with poor clinical outcome in emergency department (ED) patients presenting with AIS.
We conducted a prospective cohort study using a stroke registry enrolling all ED patients with AIS from 10/2007 through 6/2009. Poor clinical outcome was defined as death, placement in a nursing home for purposes other than rehabilitation, or hospice within 30 days of ED presentation. A BUN/Cr ratio of ≥15 was considered elevated. (IQR). Logistic regression was performed adjusted for age >64 years, NIHSS >8, diabetes, prior CVA, and coma at presentation reporting odds ratios with 95% confidence intervals.
324 patients had a final diagnosis of AIS. 163 (50%) were female, 19 (6%) died, 44 (14%) received t-PA, and 89 (27%) had a poor clinical outcome. The median NIHSS, BUN and Cr were 4 (IQR 1-9), 14 mg/dL (IQR 11-21), and 1.02 mg/dL (IQR 0.87-1.27) respectively. The median BUN/Cr was 13.9 (IQR 10.6-18.5). The variables associated with a poor clinical outcome were: high NIHSS OR 6.5 (3.6-11.8), age >64 years OR 2.7 (1.5-5.0), and BUN/Cr ratio of ≥15 OR 2.2 (1.2-4.0).
An elevated BUN/Cr ratio in patients with AIS is associated with poor outcome at 30 days. Further study is needed to see if acutely addressing hydration status in ED patients with AIS can alter outcome.
脱水可能会损害急性缺血性卒中（AIS）患者的脑氧输送并恶化临床结局。我们评估了作为脱水标志物的血尿素氮与肌酐比值（BUN/Cr）升高是否与急诊科（ED）中表现为AIS的患者的不良临床结局相关。
我们进行了一项前瞻性队列研究，使用卒中登记系统纳入了2007年10月至2009年6月期间所有ED中的AIS患者。不良临床结局定义为在ED就诊后30天内死亡、因康复以外的目的入住疗养院或临终关怀机构。BUN/Cr比值≥15被认为升高（四分位间距）。进行逻辑回归分析，并对年龄>64岁、美国国立卫生研究院卒中量表（NIHSS）>8、糖尿病、既往卒中（CVA）和就诊时昏迷进行校正，报告比值比及95%置信区间。
324例患者最终诊断为AIS。163例（50%）为女性，19例（6%）死亡，44例（14%）接受了组织型纤溶酶原激活剂（t-PA）治疗，89例（27%）有不良临床结局。NIHSS、BUN和Cr的中位数分别为4（四分位间距1 - 9）、14mg/dL（四分位间距11 - 21）和1.02mg/dL（四分位间距0.87 - 1.27）。BUN/Cr的中位数为13.9（四分位间距10.6 - 18.5）。与不良临床结局相关的变量为：NIHSS高，比值比6.5（3.6 - 11.8）；年龄>64岁，比值比2.7（1.5 - 5.0）；BUN/Cr比值≥15，比值比2.2（1.2 - 4.0）。
AIS患者中升高的BUN/Cr比值与30天时的不良结局相关。需要进一步研究以确定对ED中AIS患者的脱水状态进行急性处理是否能改变结局。
