To investigate the predictive value of dehydration for the early neurological deterioration (END) in non-thrombolysed patients with acute ischemic stroke (AIS).

With a retrospective case series study, 624 patients with AIS within 24 h of onset admitted to the Department of Emergency Medicine, the Second People’s Hospital of Shenzhen between January 2016 and December 2019 were enrolled, including 69 in the END group and 555 in the non-END group. END was defined as an increase ≥ND was defined as an increaseEND group and 555 in t(NIHSS) score during the first 72 h of hospitalization. The demographics, baseline clinical data and laboratory findings between the END and non-END groups were compared. Multivariate logistic regression analysis was used to determine the independent risk factors for END. Receiver operating characteristic(ROC)curve was used to analyze the predictive value of BUN/Cr for END.

There were significant differences in the proportion diabetes mellitus, baseline NIHSS score, blood pressure, blood glucose, white blood cell, D-dimer, erythrocyte sedimentation rate(ESR), BUN/Cr, plasma osmolality, hospital stay and modified Rankin scale(mRS) score on discharge between the END group and the non-END group(all P<0.05). Multivariate logistic regression analysis showed that baseline NIHSS score(odds ratio OR =1.175, 95% CI 1.075-1.284; P<0.001), systolic blood pressure(OR=1.021, 95% CI 1.002-1.040; P=0.029), BUN/Cr(OR=1.091, 95% CI 1.023-1.163; P=0.008), and ESR(OR =1.031, 95% CI 1.010-1.052; P=0.004) were the independent risk factors for END. ROC curve analysis showed that the area under the curve of BUN/Cr predicting END was 0.652(95% CI 0.588-0.715; P<0.001), the optimal cut-off value was 16.6, and the sensitivity and specificity were 75% and 54% respectively. ROC curve analysis showed that the prognostic equation(0.087×BUN/Cr+ 0.03×ESR+ 0.161×NIHSS+ 0.021×systolic blood pressure - 8.036)had a better predictive value for END, and the area under the curve was 0.835(95% CI 0.776-0.894; P<0.001), the sensitivity and specificity were 86% and 71% respectively.

BUN/Cr as a dehydration marker is related to the risk of END in non-thrombolysed patients with AIS, and has a certain predictive value for END. Plasma osmolality is not significantly associated with the risk for END.