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Mannitol use in acute stroke: case fatality at 30 days and 1 year
Dániel Bereczki1, László Mihálka, Szabolcs Szatmári
1Department of Neurology, Health Science and Medical Center, University of Debrecen, Debrecen, Nagyerdei krt. 98, H-4012, Hungary. bereczki@jaguar.dote.hu
Background And Purpose:
Mannitol is used worldwide to treat acute stroke, although its efficacy and safety have not been proven by randomized trials.
Methods:
In a tricenter, prospective study, we analyzed the 30-day and 1-year case fatality with respect to mannitol treatment status in 805 patients consecutively admitted within 72 hours of stroke onset. Confounding factors were compared between treated and nontreated patients.
Results:
Two thirds of the patients received intravenous mannitol as part of their routine treatment (mean dose, 47+/-22 g/d; mean duration, 6+/-3 days). The case fatality was 25% versus 16% (P=0.006) at 30 days and 38% versus 25% (P<0.001) at 1 year in the-mannitol treated and nontreated groups, respectively. Mannitol treatment effect was adjusted for age, stroke severity, fever in the first 3 days, and aspirin treatment (for ischemic strokes) in logistic regression models. Depending on the factors entered into the model, either no effect or harm could be attributed to mannitol. When the analysis was restricted to those admitted within 24 hours (n=568), case fatality differed significantly only at 1 year (35% in treated and 26% in nontreated patients, P=0.044). Although the prognostic scores of the Scandinavian Neurological Stroke Scale were similar in treated and nontreated patients, both in ischemic and hemorrhagic strokes, the patient groups differed in several factors that might also have influenced survival.
Conclusions:
Based on the results of this study, no recommendations can be made on the use of mannitol in acute stroke, and properly randomized, controlled trials should be performed to come to a final conclusion.
Insights
Mannitol use in acute stroke shows no proven benefit and potential harm. Further randomized trials are needed to determine its efficacy and safety in stroke patients.
Area of Science:
- Neurology
- Clinical Trials
- Pharmacology
Background:
- Mannitol is widely used for acute stroke treatment globally.
- Its efficacy and safety lack validation through randomized controlled trials.
Purpose of the Study:
- To analyze the impact of mannitol on case fatality in acute stroke patients.
- To investigate potential confounding factors influencing mannitol's effect.
Main Methods:
- Prospective, tricenter study of 805 acute stroke patients.
- Analysis of 30-day and 1-year case fatality based on mannitol treatment status.
- Logistic regression models adjusted for confounding factors.
Main Results:
- Higher case fatality observed in mannitol-treated vs. non-treated groups at 30 days (25% vs. 16%) and 1 year (38% vs. 25%).
- Adjusted analysis indicated either no effect or potential harm from mannitol.
- Significant difference in 1-year fatality (35% vs. 26%) for patients admitted within 24 hours.
Conclusions:
- Current evidence does not support recommendations for mannitol use in acute stroke.
- Randomized, controlled trials are essential for definitive conclusions on mannitol's role.
