Influence of raised plasma osmolality on clinical outcome after acute stroke
Abstract
Background and Purpose —Abnormal physiological parameters after acute stroke may induce early neurological deterioration. Studies of the effect of dehydration on stroke outcome are limited. We examined the association of raised 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 admission 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 stratified 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 (>296 mOsm/kg) and survival, adjusting for stroke severity. Linear regression was performed to examine the pattern of plasma osmolality across hydration groups. 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/kg, SD 11.7) plasma osmolality were significantly higher in those who died compared 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 osmolality >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 determine whether correcting dehydration after stroke improves outcome.
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Older adults with raised serum osmolality (>300 mOsm/kg or equivalent) have an increased risk of mortality.
“High-quality cohort studies which have adjusted for key confounding factors have consistently found that older adults with raised serum osmolality (>300 mOsm/kg or equivalent) have an increased risk of mortality (216-218)”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [216]
The Outcome table reports that measured plasma osmolality >296 mOsm/kg on admission was associated with higher three-month mortality after adjustment for key confounders (OR 2.4). The Results give a mean age of 73.2 years, but the cohort comprised acute stroke patients, not older adults generally; the tested threshold was >296, not >300 mOsm/kg. (LLM, conf=0.88)
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ESPEN practical guideline: Clinical nutrition and hydration in geriatrics
Volkert, D., Beck, A. M., Cederholm, T., Cruz-Jentoft, A., Hooper, L., Kiesswetter, E., Maggio, M., Raynaud-Simon, A., Sieber, C., Sobotka, L., et al. (2022) · Clinical Nutrition · doi:10.1016/j.clnu.2022.01.024 · Cited by 516 · see citing works
Water-loss dehydration and aging
Hooper, L., Bunn, D., Jimoh, F. O., & Fairweather-Tait, S. J. (2014) · Mechanisms of Ageing and Development · doi:10.1016/j.mad.2013.11.009 · Cited by 283 · see citing works
Water, hydration, and health: Nutrition Reviews©, Vol. 68, No. 8
Popkin, B. M., D'Anci, K. E., & Rosenberg, I. H. (2010) · Nutrition Reviews · doi:10.1111/j.1753-4887.2010.00304.x · Cited by 1,175 · see citing works
- Authors
- Bhalla, A., Sankaralingam, S., Dundas, R., Swaminathan, R., Wolfe, C. D. A., & Rudd, A. G.
- Affiliations
- Guy's Hospital (GB)
- Venue
- Stroke
- Published
- 2000-09
- Volume
- 31
- Issue
- 9
- Pages
- 2043-2048
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W2034669696
- Cited by
- 219
- References
- 1
- Citations by year
- 2026: 5 · 2025: 12 · 2024: 10 · 2023: 13 · 2022: 11 · 2021: 11 · 2020: 9 · 2019: 12 · 2018: 10 · 2017: 11 · 2016: 15 · 2015: 12 · 2014: 6 · 2013: 10 · 2012: 11
- FWCI
- 3.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
- Health Sciences › Medicine › Neurology › Intracerebral and Subarachnoid Hemorrhage Research
- Keywords
- plasma osmolality, acute stroke, dehydration, stroke mortality, hydration, intravenous hydration, oral hydration, neurological deterioration, stroke outcome
- MeSH terms
- Acute Disease, Administration, Oral, Age Factors, Aged, Dehydration, Female, Fluid Therapy, Hospitalization, Humans, Infusions, Intravenous, Male, Osmolar Concentration, Plasma, Prospective Studies, Regression Analysis, Sex Factors, Time Factors, Logistic Models, Survival Analysis, Stroke
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