Urine-Specific Gravity-Based Hydration Prevents Stroke in Evolution in Patients with Acute Ischemic Stroke

Area of Science:

• Neurology
• Internal Medicine
• Clinical Research

Background:

• Early neurological deterioration, termed stroke-in-evolution (SIE), is a significant complication of ischemic stroke, leading to poorer patient outcomes.
• Previous research suggests a correlation between a patient's hydration status and the likelihood of developing SIE.
• This study investigates the potential of rehydration therapy, guided by urine-specific gravity (USG), to mitigate the occurrence of SIE.

Purpose of the Study:

• To test the hypothesis that rehydration therapy, guided by urine-specific gravity (USG) measurements, can reduce the incidence of stroke-in-evolution (SIE) in patients with acute ischemic stroke.
• To evaluate the efficacy of USG-guided hydration compared to standard rehydration protocols in preventing neurological deterioration.

Main Methods:

• A single-arm prospective study design was employed, utilizing historical controls for comparison.
• Patients in the study group received rehydration when their urine-specific gravity (USG) exceeded 1.010.
• Stroke-in-evolution (SIE) was defined as an increase of 4 or more points on the National Institutes of Health Stroke Scale (NIHSS) within 3 days of stroke onset.

Main Results:

• Analysis included 445 patients: 167 in the study group and 278 in the control group.
• The incidence of SIE was numerically lower in the USG-guided hydration group (5.9%) compared to the control group (11.5%), though not statistically significant overall.
• Significantly fewer patients with an admission USG > 1.010 developed SIE in the study group (6.1%) versus the control group (16.0%; P=.021).
• Multivariate analysis identified USG-based hydration as an independent protective factor against SIE.

Conclusions:

• Urine-specific gravity (USG) presents a practical and effective tool for guiding fluid therapy in acute ischemic stroke management.
• USG-guided hydration therapy demonstrated a significant reduction in stroke-in-evolution (SIE) incidence among patients with elevated USG levels at admission.