Stroke-in-evolution (SIE) after ischemic stroke is associated with poor outcomes [1-4]. As findings from our previous study suggest a link between hydration status and SIE [5], we tested the hypothesis that rehydration therapy, administered on the basis of urine-specific gravity (USG) findings, would reduce the development of SIE.

Our study included patients with ischemic stroke (study group, n = 121) treated between October 2007 and April 2012. A USG > 1·010 was taken to indicate dehydration, and patients were fed via nasogastric tube, given bolus intravenous fluid support, and advised to drink water as necessary. We also included a cohort of patients who received standard rehydration therapy on the basis of physical examination findings (control group, n = 278).

On admission, there were significant between-group differences in diastolic blood pressure, mean blood pressure, and blood urea nitrogen/creatinine ratio, blood creatinine concentration, and white blood cell count. The proportion of patients who developed SIE was numerically lower in the study (6·7%; 8/121) compared with the control group (11·5%; 32/278). The National Institutes of Health Stroke Scale (NIHSS) scores were significantly lower in the study compared with the control group on days 1, 2, and 3 (all P < 0·05). There were no significant within-group differences in NIHSS scores in the study group, whereas NIHSS scores significantly decreased with time in the control group (P < 0·05).

Although we found that a lower proportion of patients in the study group developed SIE than patients in the control group, there was no evidence of improved outcomes. As there were several between-group differences in baseline characteristics that may have skewed our results, we suggest that larger scale, better controlled studies are needed to further investigate the potential effectiveness of rehydration therapy on the basis of USG monitoring for reducing the incidence of SIE after ischemic stroke.


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  2. References
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    Toni D, Fiorelli M, Gentile M et al. Progressing neurological deficit secondary to acute ischemic stroke. A study on predictability, pathogenesis, and prognosis. Arch Neurol 1995; 52:670675.
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    Toni D, Fiorelli M, Zanette EM et al. Early spontaneous improvement and deterioration of ischemic stroke patients. A serial study with transcranial Doppler ultrasonography. Stroke 1998; 29:11441148.
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    Sumer M, Ozdemir I, Erturk O. Progression in acute ischemic stroke: frequency, risk factors and prognosis. J Clin Neurosci 2003; 10:177180.
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    Lin LC, Fann WC, Chou MH, Chen HW, Su YC, Chen JC. Urine specific gravity as a predictor of early neurological deterioration in acute ischemic stroke. Med Hypotheses 2011; 77:1114.