Volume of Plasma Expansion and Functional Outcomes in Stroke.
Miller JB, Lewandowski C, Wira CR, Taylor A, Burmeister C, and Welch R. Volume of plasma expansion and functional outcomes in stroke. Neurocrit Care 2016.
BACKGROUND: Plasma expansion in acute ischemic stroke has potential to improve cerebral perfusion, but the long-term effects on functional outcome are mixed in prior trials. The goal of this study was to evaluate how the magnitude of plasma expansion affects neurological recovery in acute stroke.
METHODS: This was a secondary analysis of data from the Albumin in Acute Stroke Part 2 trial investigating the relationship between the magnitude of overall intravenous volume infusion (crystalloid and colloid) to clinical outcome. The data were inclusive of 841 patients with a mean age of 64 years and a median National Institutes of Health Stroke Scale (NIHSS) of 11. In a multivariable-adjusted logistic regression model, this analysis tested the volume of plasma expansion over the first 48 h of hospitalization as a predictor of favorable outcome, defined as either a modified Rankin Scale score of 0 or 1 or a NIHSS score of 0 or 1 at 90 days. This model included all study patients, irrespective of albumin or isotonic saline treatment.
RESULTS: Patients that received higher volumes of plasma expansion more frequently had large vessel ischemic stroke and higher NIHSS scores. The multivariable-adjusted model revealed that there was decreased odds of a favorable outcome for every 250 ml additional volume plasma expansion over the first 48 h (OR 0.91, 95 % CI, 0.88-0.94).
CONCLUSIONS: The present study demonstrates an association between greater volume of plasma expansion and worse neurological recovery.
Medical Subject Headings
Aged; Brain Ischemia; Female; Humans; Male; Middle Aged; Outcome Assessment (Health Care); Plasma; Serum Albumin; Sodium Chloride; Stroke