Blood Urea Nitrogen/Creatinine Ratio And Urine Specific Gravity In Acute Ischemic Stroke Patients As A Predictor Of Early Neurological Deterioration-One Year Hospital Based Cross Sectional Study

Abstract

The WHO clinically defines stroke as ‘the rapid development of clinical signs and symptoms of a focal neurological disturbance lasting more than 24 hours or leading to death with no apparent cause other than vascular origin’ (WHO 2005). Stroke has two main subtypes: Ischemic and Hemorrhagic stroke. An ischemic stroke may result in dysphagia which impairs fluid intake leading to dehydration. Acute stroke individuals with dysphagia are at higher risk for dehydration.Patients with stroke associated with dehydration are at increased risk of early neurological damage. Early neurological deterioration occurs in about 20 to 40% of these patients and results in functional disability and mortality Usually they exhibit elevated BUN/Creatinine and Urine specific gravity (biomarker for hydration status), acute stroke patients in a volume contracted status demonstrate worse short-term outcomes compared to euvolemic patients, independent of infarct size. Early neurological deterioration is defined as worsening of neurological condition as indicated by an increase in NIHSS score by 3 or more points within first 3 days. Early identification of dehydration is essential for timely intervention to improve outcome of stroke in evolution patients. Blood urea nitrogen to Creatinine ratio (BUN/Cr) and Urine specific gravity are frequently used in subjects with cerebral infarction as a measurement of renal function and by various studies has shown BUN/creatinine ratio and USG are both used in the prediction of ill outcomes in individuals with stroke. The effect of dehydration at presentation on the risk and outcome of ischemic stroke has been evaluated using Blood urea nitrogen (BUN) and urine specific gravity Bun/creatinine ratio and urine specific gravity as a laboratory investigation on day 1,2,3 is used for measurement of hydration status in our study. Methods and materials: 60patients admitted in the Wards and ICU of General medicine and Neuromedicine at KLES Dr.Prabhakar kore hospital, Belagavi (Karnataka) with Acute ischemic stroke within 24 hours of onset above 18 years NCCT/MRI head was done. National institute health stroke scale (NIHSS) was calculated on the day of admission and worsening is seen based on NIHSS score increment of ≥ 3 points. Parameters like blood urea/creatinine ratio and urine specific gravity was repeated for 3 continuous days and at the time of discharge Results In our present study, out of 60 patients admitted with 1st episode of acute ischemic stroke various demographic like age, sex, clinical parameters neurological signs, habits, co-morbid condition like hypertension and coronary artery disease and laboratory parameters were compared with NIHSS score In our study group we did not found any correlation with day wise estimation BUN/creatinine ratio and urine specific gravity with early neurological deterioration Discussion: We did not find any significant correlation between urine specific gravity and BUN/creatinine ratio although some authors have found Urine specific gravity and BUN/Creatinine as an independent predictors for END in acute ischemic stroke patients this was in sharp contrast with our study of 60 patients which can be attributed to small sample size and various demographic conditions like age, sex, habits, co morbid conditions. Conclusions: On comparing different lab parameters like urea, creatinine, BUN/Creatinine ratio and Urine specific Gravity with NIHSS scoring did not have significant correlation as far as patient outcome was concerned.