Influence of raised plasma osmolality on clinical outcome after acute stroke

Background and Purpose-Abnormal physiological parameters after acute stroke may induce early neurological deterioration. Studies of the effect of dehy dration on stroke outcome are limited. We examined the association of raise d plasma osmolality on stroke outcome at 3 months and the change of plasma osmolality with hydration during the first week after stroke. Methods-Acute stroke patients had their plasma osmolality measured at admis sion and at days 1, 3, and 7. Maximum plasma osmolality and the area under curve (AUC) were also calculated during the first week. Patients were strat ified according to how they were hydrated: orally, intravenously, or both. Outcome included survival at 3 months after stroke. Logistic regression was performed to examine the association between raised plasma osmolality (>29 6 mOsm/kg) and survival, adjusting for stroke severity. Linear regression w as performed to examine the pattern of plasma osmolality across hydration g roups. Results-One hundred sixty-seven patients were included. Mean admission (300 mOsm/kg, SD 11.4), maximum (308.1 mOsm/kg, SD 17.1), and AUC (298.3 mOsm/k g, SD 11.7) plasma osmolality were significantly higher in those who died c ompared with survivors (293.1 mOsm/kg [SD 8.2], 297.7 mOsm/kg [SD 8.7], and 291.7 mOsm/kg [SD 8.1], respectively; P<0.0001). Admission plasma osmolali ty >296 mOsm/kg was significantly associated with mortality (OR 2.4, 95% CI 1.0 to 5.9). In patients hydrated intravenously, there was no significant fall in plasma osmolality compared with patients hydrated orally (P=0.68). Conclusions-Raised plasma osmolality on admission is associated with stroke mortality, after correcting for case mix. Correction of dehydration after stroke requires a more systematic approach. Trials are required to determin e whether correcting dehydration after stroke improves outcome.