Water-Electrolyte Disturbances in Patients With Severe Ischemic Stroke

BACKGROUND: Elevated plasma osmolality is recognized as a predictor of mortality in cardiovascular diseases, including stroke; however, the association between plasma hyperosmolality and mortality in severe acute ischemic stroke (IS) remains to be fully elucidated.

AIM: This study aimed to investigate the association between plasma osmolality and mortality in patients with severe IS, considering stroke subtype.

METHODS: This study included 150 patients with severe IS of various localizations within 24 hours of symptom onset. All patients had a first-ever stroke, including 61 with cardioembolic and 89 with atherothrombotic subtypes. Plasma and urine osmolality were measured, along with key plasma osmolytes: sodium, potassium, glucose, urea, and protein, as well as urinary sodium levels. Plasma antidiuretic hormone and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were also assessed.

RESULTS: Among water-electrolyte disturbances in severe IS, hyperosmolar syndrome occurred 2.5 times more frequently than hypoosmolar syndrome. Hyperosmolar syndrome was 1.5 times more common in patients with the atherothrombotic subtype than in those with the cardioembolic subtype. Hyperosmolar syndromes in stroke were associated with a higher mortality rate (69.3%) compared to hypoosmolar syndromes.

CONCLUSION: The obtained results on the association between plasma osmolality and mortality in patients with severe IS indicate that hyperosmolar syndromes are the most common type of water-electrolyte disturbances and are more frequently observed in the atherothrombotic rather than the cardioembolic subtype. The identified association between osmolality and mortality highlights the need for new treatment strategies targeting water-electrolyte disturbances in severe IS.