Impact of early and rapid hydration for patients with ischemic stroke within 24 hours of onset

<h2>Abstract</h2> Acute ischemic stroke (AIS) occurs due to a sudden interruption of blood flow to the brain, leading to rapid cell death and neurological deficits. Early neurological deterioration (END) affects up to one-third of AIS patients, resulting in higher mortality and disability. Dehydration at the time of stroke, indicated by an elevated blood urea nitrogen/creatinine ratio (BUN/Cre ratio), is a significant risk factor for END. Hydration therapy may reduce END and improve outcomes. This study evaluates the impact of rapid hydration therapy, implemented since January 2021 at Chiayi Chang Gung Health Systems, on AIS patients. This retrospective analysis included 1148 AIS patients, with 824 receiving regular hydration therapy, and 324 receiving rapid hydration therapy. Outcomes were assessed using National Institutes of Health Stroke Scale (NIHSS) scores, modified Rankin scale, and END incidence. There were no significant differences in demographics or baseline NIHSS scores or stroke risk factors between the groups. The rapid hydration group had lower END incidence (16.4 % vs. 24.3 %, p = 0.003) and higher favorable outcomes at 3 months (52.2 % vs. 45.4 %, p = 0.038). Rapid hydration was associated with lower odds of END [odds ratio (OR), 0.66; 95 % confidence interval (CI), 0.47–0.93, p = 0.017] in AIS patients, particularly in patients with a BUN/Cre ratio ≥15 and baseline NIHSS ≤10 (OR, 0.55; 95 % CI, 0.38–0.91; p = 0.021) or in those with a BUN/Cre ratio ≥15 and stroke onset ≤12 h (OR, 0.56; 95 % CI, 0.34–0.92; p = 0.023). Multivariate analysis showed that age, prior stroke and initial NIHSS were independent predictors of 3-month outcomes. Rapid intravenous hydration significantly reduced the risk of END in AIS patients, especially those with dehydration and milder stroke severity. These findings suggest that rapid hydration is a simple, cost-effective intervention that should be considered in clinical practice. Further prospective, multicenter trials are necessary to validate these results and refine patient selection criteria.