Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Elevated Blood Urea Nitrogen/Creatinine Ratio Is Associated with Venous Thromboembolism in Patients with Acute Ischemic Stroke

  • Kim, Hoon (Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Kiwon (Department of Neurosurgery and Neurology, The University of Texas Medical School) ;
  • Choi, Huimahn A. (Department of Neurosurgery and Neurology, The University of Texas Medical School) ;
  • Samuel, Sophie (Department of Pharmacy, Memorial Hermann - Texas Medical Center) ;
  • Park, Jung Hyn (Department of Neurosurgery, Dongtan Sacred Heart Hospital, Hallym University Medical Center) ;
  • Jo, Kwang Wook (Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2016.10.29
  • Accepted : 2017.03.14
  • Published : 2017.11.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Although venous thromboembolism (VTE) is frequently related to dehydration, the impact of dehydration on VTE in acute ischemic stroke (AIS) is not clear. This study investigated whether dehydration, as measured by blood urea nitrogen (BUN)/creatinine (Cr) ratio, influences the occurrence of VTE in patients with AIS. Methods : This is a retrospective study of patients with AIS between January 2012 and December 2013. Patients with newly diagnosed AIS who experienced prolonged hospitalization for at least 4 weeks were included in this study. Results : Of 182 patients included in this study, 17 (9.3%) suffered VTE during the follow-up period; in two cases, VTE was accompanied by deep vein thrombosis and pulmonary embolism. Patients with VTE were more frequently female and had higher National Institutes of Health Stroke Scale (NIHSS) score, more lower limb weakness, and elevated blood urea nitrogen BUN/Cr ratio on admission. In a multivariate analysis, BUN/Cr ratio >15 (odds ratio [OR] 8.75) and severe lower limb weakness (OR 4.38) were independent risk factors for VTE. Conclusion : Dehydration on admission in cases of AIS might be a significant independent risk factor for VTE.

Keywords

References

  1. Agrawal M, Swartz R : Acute renal failure. Am Fam Physician 61 : 2077-2088, 2000
  2. Anderson FA Jr, Spencer FA : Risk factors for venous thromboembolism. Circulation 107(23 Suppl 1) : I9-I16, 2003 https://doi.org/10.1161/01.CIR.0000046771.12875.6C
  3. Ansell JE : Air travel and venous thromboembolism--is the evidence in? N Engl J Med 345 : 828-829, 2001 https://doi.org/10.1056/NEJM200109133451110
  4. Bembenek J, Karlinski M, Kobayashi A, Czlonkowska A : Early strokerelated deep venous thrombosis: risk factors and influence on outcome. J Thromb Thrombolysis 32 : 96-102, 2011 https://doi.org/10.1007/s11239-010-0548-3
  5. Bennett JA, Thomas V, Riegel B : Unrecognized chronic dehydration in older adults: examining prevalence rate and risk factors. J Gerontol Nurs 30 : 22-28; quiz 52-53, 2004
  6. Bhalla A, Sankaralingam S, Dundas R, Swaminathan R, Wolfe CD, Rudd AG : Influence of raised plasma osmolality on clinical outcome after acute stroke. Stroke 31 : 2043-2048, 2000 https://doi.org/10.1161/01.STR.31.9.2043
  7. Bhatia K, Mohanty S, Tripathi BK, Gupta B, Mittal MK : Predictors of early neurological deterioration in patients with acute ischaemic stroke with special reference to blood urea nitrogen (BUN)/creatinine ratio & urine specific gravity. Indian J Med Res 141 : 299-307, 2015 https://doi.org/10.4103/0971-5916.156564
  8. Bounds JV, Wiebers DO, Whisnant JP, Okazaki H : Mechanisms and timing of deaths from cerebral infarction. Stroke 12 : 474-477, 1981 https://doi.org/10.1161/01.STR.12.4.474
  9. Broderick JP, Palesch YY, Demchuk AM, Yeatts SD, Khatri P, Hill MD, et al. : Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 368 : 893-903, 2013 https://doi.org/10.1056/NEJMoa1214300
  10. CLOTS Trials Collaboration, Dennis M, Sandercock PA, Reid J, Graham C, Murray G, et al. : Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial. Lancet 373 : 1958-1965, 2009 https://doi.org/10.1016/S0140-6736(09)60941-7
  11. Goldman RD, Friedman JN, Parkin PC : Validation of the clinical dehydration scale for children with acute gastroenteritis. Pediatrics 122 : 545-549, 2008 https://doi.org/10.1542/peds.2007-3141
  12. Gonzalez-Alonso J, Calbet JA, Nielsen B : Muscle blood flow is reduced with dehydration during prolonged exercise in humans. J Physiol 513(Pt 3) : 895-905, 1998 https://doi.org/10.1111/j.1469-7793.1998.895ba.x
  13. Harvey RL : Prevention of venous thromboembolism after stroke. Top Stroke Rehabil 10 : 61-69, 2003 https://doi.org/10.1310/54NU-U4CP-5KC8-JM9W
  14. Hull RD : Revisiting the past strengthens the present: an evidence-based medicine approach for the diagnosis of deep venous thrombosis. Ann Intern Med 142 : 583-585, 2005 https://doi.org/10.7326/0003-4819-142-7-200504050-00015
  15. Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, et al. : Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 44 : 870-947, 2013 https://doi.org/10.1161/STR.0b013e318284056a
  16. Kelly J, Rudd A, Lewis RR, Coshall C, Moody A, Hunt BJ : Venous thromboembolism after acute ischemic stroke: a prospective study using magnetic resonance direct thrombus imaging. Stroke 35 : 2320-2325, 2004 https://doi.org/10.1161/01.STR.0000140741.13279.4f
  17. Kelly J, Rudd A, Lewis RR, Coshall C, Parmar K, Moody A, et al. : Screening for proximal deep vein thrombosis after acute ischemic stroke: a prospective study using clinical factors and plasma D-dimers. J Thromb Haemost 2 : 1321-1326, 2004 https://doi.org/10.1111/j.1538-7836.2004.00843.x
  18. Landi G, D'Angelo A, Boccardi E, Candelise L, Mannucci PM, Morabito A, et al. : Venous thromboembolism in acute stroke. Prognostic importance of hypercoagulability. Arch Neurol 49 : 279-283, 1992 https://doi.org/10.1001/archneur.1992.00530270093024
  19. Leibovitz A, Baumoehl Y, Lubart E, Yaina A, Platinovitz N, Segal R : Dehydration among long-term care elderly patients with oropharyngeal dysphagia. Gerontology 53 : 179-183, 2007 https://doi.org/10.1159/000099144
  20. Liu CH, Lin SC, Lin JR, Yang JT, Chang YJ, Chang CH, et al. : Dehydration is an independent predictor of discharge outcome and admission cost in acute ischaemic stroke. Eur J Neurol 21 : 1184-1191, 2014 https://doi.org/10.1111/ene.12452
  21. Marik PE, Andrews L, Maini B : The incidence of deep venous thrombosis in ICU patients. Chest 111 : 661-664, 1997 https://doi.org/10.1378/chest.111.3.661
  22. Noel P, Gregoire F, Capon A, Lehert P : Atrial fibrillation as a risk factor for deep venous thrombosis and pulmonary emboli in stroke patients. Stroke 22 : 760-762, 1991 https://doi.org/10.1161/01.STR.22.6.760
  23. O'Neill PA, Davies I, Fullerton KJ, Bennett D : Fluid balance in elderly patients following acute stroke. Age Ageing 21 : 280-285, 1992 https://doi.org/10.1093/ageing/21.4.280
  24. Oczkowski WJ, Ginsberg JS, Shin A, Panju A : Venous thromboembolism in patients undergoing rehabilitation for stroke. Arch Phys Med Rehabil 73 : 712-716, 1992
  25. Pottier P, Hardouin JB, Lejeune S, Jolliet P, Gillet B, Planchon B : Immobilization and the risk of venous thromboembolism. A meta-analysis on epidemiological studies. Thromb Res 124 : 468-476, 2009 https://doi.org/10.1016/j.thromres.2009.05.006
  26. Riccardi A, Chiarbonello B, Minuto P, Guiddo G, Corti L, Lerza R : Identification of the hydration state in emergency patients: correlation between caval index and BUN/creatinine ratio. Eur Rev Med Pharmacol Sci 17 : 1800-1803, 2013
  27. Ronning OM, Guldvog B : Stroke unit versus general medical wards, II: neurological deficits and activities of daily living: a quasi-randomized controlled trial. Stroke 29 : 586-590, 1998 https://doi.org/10.1161/01.STR.29.3.586
  28. Rowat A, Graham C, Dennis M : Dehydration in hospital-admitted stroke patients: detection, frequency, and association. Stroke 43 : 857-859, 2012 https://doi.org/10.1161/STROKEAHA.111.640821
  29. Schrock JW, Glasenapp M, Drogell K : Elevated blood urea nitrogen/creatinine ratio is associated with poor outcome in patients with ischemic stroke. Clin Neurol Neurosurg 114 : 881-884, 2012 https://doi.org/10.1016/j.clineuro.2012.01.031
  30. Skaf E, Stein PD, Beemath A, Sanchez J, Bustamante MA, Olson RE : Venous thromboembolism in patients with ischemic and hemorrhagic stroke. Am J Cardiol 96 : 1731-1733, 2005 https://doi.org/10.1016/j.amjcard.2005.07.097
  31. Steiner MJ, DeWalt DA, Byerley JS : Is this child dehydrated? JAMA 291 : 2746-2754, 2004 https://doi.org/10.1001/jama.291.22.2746
  32. Sulter G, De Keyser J : From stroke unit care to stroke care unit. J Neurol Sci 162 : 1-5, 1999 https://doi.org/10.1016/S0022-510X(98)00298-6
  33. Turpie AG, Levine MN, Hirsh J, Carter CJ, Jay RM, Powers PJ, et al. : Double-blind randomised trial of Org 10172 low- molecular-weight heparinoid in prevention of deep-vein thrombosis in thrombotic stroke. Lancet 1 : 523-526, 1987
  34. Vega RM, Avner JR : A prospective study of the usefulness of clinical and laboratory parameters for predicting percentage of dehydration in children. Pediatr Emerg Care 13 : 179-182, 1997 https://doi.org/10.1097/00006565-199706000-00001
  35. Virchow R : Thrombose und embolie. Gefassentzundung und septische infektion in Virchow R (ed) : Gesammelte abhandlungen zur wissenschaftlichen medicin. Frankfurt : Verlag von Meidinger Sohn & Comp, 1856, pp219-732
  36. White RH, Zhou H, Romano PS : Incidence of idiopathic deep venous thrombosis and secondary thromboembolism among ethnic groups in California. Ann Intern Med 128 : 737-740, 1998 https://doi.org/10.7326/0003-4819-128-9-199805010-00006
  37. Yilmaz K, Karabocuoglu M, Citak A, Uzel N : Evaluation of laboratory tests in dehydrated children with acute gastroenteritis. J Paediatr Child Health 38 : 226-228, 2002 https://doi.org/10.1046/j.1440-1754.2002.00792.x

Cited by

  1. Association between Blood Urea Nitrogen-to-creatinine Ratio and Three-Month Outcome in Patients with Acute Ischemic Stroke vol.16, pp.2, 2017, https://doi.org/10.2174/1567202616666190412123705
  2. Dehydration Status Predicts Short-Term and Long-Term Outcomes in Patients with Cerebral Venous Thrombosis vol.30, pp.2, 2017, https://doi.org/10.1007/s12028-018-0628-3
  3. A multidisciplinary consensus on dehydration: definitions, diagnostic methods and clinical implications vol.51, pp.3, 2017, https://doi.org/10.1080/07853890.2019.1628352
  4. Contribution of dehydration to END in acute ischemic stroke not mediated via coagulation activation vol.9, pp.6, 2017, https://doi.org/10.1002/brb3.1301
  5. Effects of the blood urea nitrogen to creatinine ratio on haemorrhagic transformation in AIS patients with diabetes mellitus vol.19, pp.None, 2019, https://doi.org/10.1186/s12883-019-1290-x
  6. Admission Dehydration Status Portends Adverse Short-Term Mortality in Patients with Spontaneous Intracerebral Hemorrhage vol.10, pp.24, 2021, https://doi.org/10.3390/jcm10245939