Tesis

Pengaruh Dehidrasi Terhadap Luaran Stroke Iskemik Akut = Influence of Dehydration on the Outcome of Acute Ischemic Stroke.

Latar belakang: Dehidrasi sering terjadi pada stroke iskemik akut (SIA) dan secara teoretik dapat memperburuk luaran pasien dengan menurunkan curah jantung dan meningkatkan viskositas darah sehingga menurunkan aliran darah otak. Tujuan penelitian ini adalah untuk mengetahui apakah dehidrasi dapat memperburuk luaran klinis dan fungsional SIA. Metode: Studi kohort dilakukan antara Oktober 2016-April 2017. Sebanyak 44 subjek ikut penelitian dan dibagi menjadi 2 kelompok berdasarkan rasio ureum/kreatinin darah dan osmolalitas serum. Dehidrasi didefinisikan sebagai rasio ureum kreatinin ³32,1 atau osmolalitas darah >310 mOsm/kg pada hari pertama masuk rumah sakit. Luaran diukur dengan 2 skala: (1) perbedaan nilai National Institutes of Health Stroke Scale (NIHSS) pada hari pertama dan ke-7 pascaawitan; dan (2) nilai modified Rankin scale (mRS) pada hari ke-30 pascaawitan. Hasil: Sebanyak 44 subjek ikut serta dalam penelitian (dehidrasi, n = 21; kontrol, n = 23). Sebanyak 25 subjek (57%) adalah pria; 4 subjek (9%) mengalami partial anterior circulation infarct (PACI) dan 40 subjek (91%) mengalami lacunar infarct (LACI). Dehidrasi tidak berhubungan dengan perburukan NIHSS (nilai p = 0.176) atau nilai mRS-30-hari yang buruk (nilai p = 1.00). Satu-satunya variabel yang berhubungan dengan perburukan NIHSS atau nilai mRS-30-hari yang buruk adalah PACI (nilai p masing-masing 0.003 and 0.001). Kesimpulan: Dehidrasi tidak berhubungan dengan perburukan NIHSS atau nilai mRS-30-hari yang buruk. Studi lebih lanjut dibutuhkan dengan kriteria diagnostik dan luaran yang lebih baik.
Kata kunci: dehidrasi; stroke iskemik akut; luaran; National Institutes of Health Stroke Scale, modified Rankin scale


Background: Dehydration occurs frequently in patients with acute ischemic stroke (AIS) and theoretically can worsen patient’s outcome by decreasing cardiac output and increasing blood viscosity resulting in decreased cerebral blood flow. The aim of this study was to determine whether dehydration worsened clinical and functional outcome of AIS. Method: A cohort study was performed between October 2016 and April 2017. There were 44 subjects with AIS recruited. Subjects were divided into 2 groups on the basis of blood ureum/creatinine ratio and serum osmolality. Dehydration is defined as ureum/creatinine ratio ³32,1 or blood osmolality >310 mOsm/kg at admission day. Outcome was measured with 2 scale: (1) National Institutes of Health Stroke Scale (NIHSS) score difference on admission compared to score at day 7 of hospitalization; and (2) modified Rankin scale (mRS) at day 30 after AIS onset. Result: A total of 44 subjects were enrolled (dehydration, n = 21; control, n = 23). 25 subjects (57%) were male; 4 subjects (9%) had partial anterior circulation infarct (PACI) and 40 subjects (91%) had lacunar infarct (LACI). Dehydration was not associated with either NIHSS worsening (p-value = 0.176) or poor 30-day-mRS (pvalue = 1.00). The only variable associated with poor NIHSS and mRS outcome was PACI (p-value 0.003 and 0.001, respectively). Conclusion: This study found that dehydration in AIS was not associated with poor 7-day-NIHSS and 30-day-mRS outcome. Further study with better diagnostic and outcome criteria is required.
Keywords: dehydration; acute ischemic stroke; outcome; National Institutes of Health Stroke Scale; modified Rankin scale