Caval Index is a Predictor of Mortality in Patients with Acute Ischemic Stroke: A Prospective Observational Study

Objective Dehydration is related with a higher risk of complications, such as venous thrombosis. Stroke occurs more frequently in the elderly, and dehydration is common in these patients. The aim of this study is to determine the dehydration in patients with acute ischemic stroke and its effect on prognosis. Methods In this observational cohort study, we included prospectively and consecutively patients who underwent intravenous fibrinolytic therapy and/or mechanic revascularization. Inferior vena cava inferior (IVC) diameter, blood urea nitrogen/creatinine ratio and glomerular filtration rate were measured at the time of first admission to the emergency department to determine volume status. Dehydration was defined as collapse of >50% in IVC diameter. Demographic and clinical data were recorded. At admission NIHSS was used for neurological severity. At discharge and three months after the stroke modified Rankin Scale (mRS) was used for functional outcome. Poor outcome was defined as mRS: 3-6. Results We evaluated 211 patients, 77% presented with anterior circulation occlusion. Dehydration was detected in 57 (34.7%) in anterior occlusion and 15 (46.8%) in posterior occlusion patients at emergency department admission. Poor outcomes were found to be more common in patients with hypovolemia and in those with anterior circulation disorder who received conservative treatment and intravenous thrombolytic therapy than in normovolemic patients (p = 0.032 and p = 0.005, respectively). Conclusion Dehydration is common in acute ischemic patients in emergency admission. Although laboratory parameters are used to detect dehydration, collapse determined by measuring IVC diameter is a fast and useful method for emergency physicians to determine volume status in acute stroke patients. Further research should aim to determine dehydration in stroke patients for fluid resuscitation in the emergency department.