Favorable outcome of blood urea nitrogen/creatinine–based hydration therapy 3 months after acute ischemic stroke

Background Dehydration is associated with acute ischemic stroke. However, the relationship between hydration therapy given during acute ischemic stroke and clinical outcomes remains unclear. Aims 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.