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Electrolyte Levels in Poor Prognosis and Early Neurological Deterioration in Patients With Acute Ischemic Stroke

Shengli Pan1, Bohuai Yu1,2, Yilin Chen1,2

  • 1Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.

Journal of Clinical Hypertension (Greenwich, Conn.)
|March 31, 2025
PubMed

Insights

Serum electrolyte levels impact stroke outcomes. Higher sodium (Na+) is linked to poor prognosis, while chloride (Cl-) and calcium (Ca2+) predict early neurological deterioration (END) in stroke patients.

Area of Science:

  • Neurology
  • Clinical Chemistry
  • Cardiovascular Medicine

Background:

  • Electrolyte imbalances are common in stroke patients.
  • Previous research links electrolytes to mortality and cardiovascular events post-stroke.
  • The specific role of electrolytes in early neurological deterioration (END) and prognosis among hypertensive stroke patients remains unclear.

Purpose of the Study:

  • To investigate the association between serum electrolyte levels and adverse outcomes in patients with acute ischemic stroke treated with thrombolysis.
  • To specifically examine the relationship between electrolytes and early neurological deterioration (END) and long-term prognosis, particularly in hypertensive individuals.

Main Methods:

  • Analysis of 1341 patients undergoing thrombolysis for acute ischemic stroke.
  • Logistic regression and restricted cubic spline analyses to assess correlations and dose-response relationships between electrolytes (Na+, Cl-, Ca2+, Mg2+) and outcomes (END, 3-month, 6-month, 1-year poor prognosis).
  • Subgroup analysis focusing on hypertensive patients.

Main Results:

  • Significant differences in chloride (Cl-), calcium (Ca2+), and magnesium (Mg2+) levels were observed based on modified Rankin Scale (mRS) scores.
  • Chloride (Cl-) was the strongest predictor for 3-month, 6-month, and 1-year poor prognosis, while calcium (Ca2+) predicted END.
  • Higher sodium (Na+) concentrations correlated with poorer prognosis, especially in hypertensive patients. Lower calcium (Ca2+) was linked to higher END risk in this subgroup.

Conclusions:

  • Serum sodium (Na+) concentration is associated with adverse clinical outcomes, while chloride (Cl-) and calcium (Ca2+) are linked to early neurological deterioration (END).
  • In hypertensive stroke patients, elevated Na+ predicts poor 6-month and 1-year outcomes, and elevated Ca2+ is associated with END.
  • Monitoring serum electrolytes may aid in the early identification of stroke patients at high risk for poor functional outcomes.

Keywords:
ENDelectrolytehypertensionischemic strokemRS

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