Bahouth Mona N, Saylor Deanna, Hillis Argye E, Gottesman Rebecca F
School of Medicine, Johns Hopkins University, Baltimore, MD, United States.
School of Nursing, Johns Hopkins University, Baltimore, MD, United States.
Front Neurol. 2022 Mar 8;13:766305. doi: 10.3389/fneur.2022.766305. eCollection 2022.
Hydration at the time of stroke may impact functional outcomes. We sought to investigate the relationship between blood pressure, hydration status, and stroke severity in patients with acute ischemic stroke (AIS).
We evaluated hydration status, determined by blood urea nitrogen (BUN)/creatinine ratio, in consecutive patients with AIS from a single comprehensive stroke center. Baseline mean arterial pressure (MAP) was analyzed using a linear spline with a knot at 90 mmHg. Baseline stroke severity was defined based on admission NIH Stroke Scale scores (NIHSSS) and MRI diffusion-weighted imaging.
Among 108 eligible subjects, 55 (51%) presented in a volume contracted state. In adjusted models, in the total sample, for every 10 mmHg higher MAP up to 90 mmHg, NIHSSS was 2.8 points lower ( = 0.053), without further statistically significant association between MAP above 90 and NIHSSS. This relationship was entirely driven by the individuals in a volume contracted state: MAP was not associated with NIHSSS in individuals who were euvolemic. For individuals in a volume contracted state, each 10 mmHg higher MAP, up to 90 mmHg, was associated with 6.9 points lower NIHSSS (95% CI -11.1, -2.6). MAP values above 90 mmHg were not related to NIHSSS in either dehydrated or euvolemic patients.
Lower MAP contributes to more severe stroke in patients who are volume contracted, but not those who are euvolemic, suggesting that hydration status and blood pressure may jointly contribute to the outcome. Hydration status should be considered when setting blood pressure goals for patients with AIS.
卒中发生时的水合状态可能会影响功能结局。我们旨在研究急性缺血性卒中（AIS）患者的血压、水合状态与卒中严重程度之间的关系。
我们对来自单一综合卒中中心的连续AIS患者进行评估，通过血尿素氮（BUN）/肌酐比值来确定水合状态。使用在90 mmHg处有节点的线性样条分析基线平均动脉压（MAP）。根据入院时美国国立卫生研究院卒中量表评分（NIHSSS）和MRI弥散加权成像定义基线卒中严重程度。
在108名符合条件的受试者中，55名（51%）呈现容量收缩状态。在调整模型中，在总样本中，MAP每升高10 mmHg直至90 mmHg，NIHSSS降低2.8分（P = 0.053），90 mmHg以上的MAP与NIHSSS之间无进一步的统计学显著关联。这种关系完全由处于容量收缩状态的个体驱动：血容量正常的个体中MAP与NIHSSS无关。对于处于容量收缩状态的个体，MAP每升高10 mmHg直至90 mmHg，NIHSSS降低6.9分（95% CI -11.1，-2.6）。脱水或血容量正常的患者中，90 mmHg以上的MAP值与NIHSSS均无关。
较低的MAP会导致容量收缩患者的卒中更严重，但血容量正常的患者并非如此，这表明水合状态和血压可能共同影响结局。为AIS患者设定血压目标时应考虑水合状态。
