Fluid excess on intensive care unit after mechanical thrombectomy after acute ischemic stroke is associated with unfavorable neurological and functional outcomes: An observational cohort study.

IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY European Stroke Journal Pub Date : 2024-08-16 DOI:10.1177/23969873241271642
Maximilian Schell, Christina Mayer, Marcel Seungsu Woo, Hannes Leischner, Marlene Fischer, Jörn Grensemann, Stefan Kluge, Patrick Czorlich, Christian Gerloff, Jens Fiehler, Götz Thomalla, Fabian Flottmann, Nils Schweingruber
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Abstract

Introduction: Endovascular thrombectomy stands as a pivotal component in the standard care for patients experiencing acute ischemic stroke with large vessel occlusion. Subsequent care for patients often extends to a neurological intensive care unit. While fluid management is integral to intensive care, the association between early fluid balance and neurological and functional outcomes post-thrombectomy has not yet been thoroughly investigated.

Methods: In a retrospective analysis of an observational, single-center study spanning from 2015 to 2021 at the University Medical Center Hamburg-Eppendorf, Germany, we enrolled stroke patients who underwent thrombectomy and received subsequent treatment in the ICU. Unfavorable functional and neurological outcome was defined as a mRS > 2 on day 90 after admission (mRS d90) or NIHSS > 5 at discharge, respectively. A multivariate regression model, adjusting for confounders, utilized the average fluid balance in the first 5 days to predict outcomes. Patients were dichotomized by their average fluid balance (>1 L vs <1 L) within the first 5 days, and a multivariate mRS d90 shift analysis was conducted after adjusting for covariates.

Results: Between 2015 and 2021, 1252 patients underwent thrombectomy, and 553 patients met the inclusion criteria (299 women [54%]). Unfavorable functional outcome was significantly associated with a higher daily average fluid balance in the first 5 days in the ICU (mRS d90 ⩽ 2: 0.3 ± 0.5 L, mRS d90 > 2: 0.7 ± 0.7 L, p = 0.02). The same association was observed for the NIHSS at discharge (NIHSS ⩽ 5: 0.3 ± 0.5 L; NIHSS > 5: 0.6 ± 0.6 L; p = 0.03). The mRS d90 shift analysis revealed significance for patients with an average fluid balance <1 L for better functional outcomes (adjusted odds ratio [AOR] 2.17; 95% confidence interval [CI] 1.54-3.07; p < 0.01).

Discussion: Fluid retention in post-thrombectomy stroke patients in the ICU is associated with poorer functional and neurological outcomes. Consequently, fluid retention emerges as an additional potential predictor for post-intervention stroke outcomes. Our findings provide an initial indication that preventing excessive fluid retention in stroke patients after endovascular thrombectomy could be beneficial for both functional and neurological recovery. Therefore, fluid retention might be an element to consider in optimizing fluid management for stroke patients.

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急性缺血性脑卒中机械性血栓切除术后重症监护病房液体过多与不利的神经和功能预后有关:一项观察性队列研究。
导言:血管内血栓切除术是急性缺血性脑卒中大血管闭塞患者标准治疗的重要组成部分。对患者的后续护理通常延伸至神经重症监护病房。虽然液体管理是重症监护不可或缺的一部分,但血栓切除术后早期液体平衡与神经和功能预后之间的关系尚未得到深入研究:在对德国汉堡大学医疗中心(University Medical Center Hamburg-Eppendorf)2015 年至 2021 年的一项单中心观察性研究进行的回顾性分析中,我们纳入了接受血栓切除术并在重症监护室接受后续治疗的中风患者。入院后第 90 天的 mRS > 2(mRS d90)或出院时 NIHSS > 5 分别定义为功能和神经系统的不良预后。在调整了混杂因素后,多变量回归模型利用前 5 天的平均液体平衡来预测结果。根据患者的平均体液平衡(>1 L vs 结果)对其进行二分:2015年至2021年间,1252名患者接受了血栓切除术,553名患者符合纳入标准(299名女性[54%])。不利的功能预后与入住重症监护室前 5 天较高的日平均液体平衡显著相关(mRS d90 ⩽ 2:0.3 ± 0.5 L,mRS d90 > 2:0.7 ± 0.7 L,p = 0.02)。出院时的 NIHSS 也有同样的关联(NIHSS ⩽ 5:0.3 ± 0.5 L;NIHSS > 5:0.6 ± 0.6 L;p = 0.03)。mRS d90 转移分析表明,平均体液平衡为 p 的患者具有显著意义:血栓切除术后脑卒中患者在重症监护室的液体潴留与较差的功能和神经功能预后有关。因此,液体潴留成为干预后中风预后的另一个潜在预测因素。我们的研究结果初步表明,防止血管内血栓切除术后脑卒中患者出现过度液体潴留有利于功能和神经系统的恢复。因此,液体潴留可能是优化中风患者液体管理时需要考虑的一个因素。
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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
期刊最新文献
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