Predictive value of hypernatremia in the hyperacute period of ischemic stroke of different pathogenetic subtypes

Abstract

Background: Acute cerebrovascular accident remains a major challenge in modern medicine, with ischemic stroke being the most common subtype. Studying ischemic stroke characteristics within the first five days after onset may help optimize therapy and predict outcomes.

Aim: To evaluate the prognostic significance of water-electrolyte imbalance in the hyperacute period of cardioembolic and atherothrombotic ischemic stroke subtypes regarding disease progression and outcomes.

Methods: This observational, single-center, prospective, randomized, single-arm study included 96 patients aged 30–80 years during the hyperacute period of severe ischemic stroke of cardioembolic and atherothrombotic subtypes. ROC analysis was conducted to determine the prognostic value of plasma sodium levels for disease outcomes.

Results: Ischemic stroke occurred in the carotid basin in 89 of 96 patients and in the vertebrobasilar basin in 7 of 96 patients, respectively. The atherothrombotic subtype was predominantly associated with vertebrobasilar basin lesions, whereas the cardioembolic subtype was primarily associated with carotid basin lesions. The highest mortality was observed in patients with hyperosmolar hypernatremic syndrome. ROC analysis demonstrated strong prognostic significance of plasma sodium levels in the hyperacute period for predicting mortality, valid across both cardioembolic and atherothrombotic ischemic stroke subtypes as well as for the entire cohort.

Conclusion: Developed in the hyperacute phase of ischemic stroke, hyperosmolar hypernatremic syndrome is an independent predictor of fatal outcomes. High prognostic value of plasma sodium levels was confirmed during the hyperacute period across different pathogenetic subtypes of ischemic stroke.

Keywords

ischemic stroke / water-electrolyte imbalance / hypernatremia / prognostic factors

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