Association between acute ⁃ phase volume load and clinical outcome in branch atheromatous disease⁃related stroke: a multicenter prospective cohort study

Objective To explore the impact of acute⁃phase volume load on clinical outcome in patients with branch atheromatous disease (BAD)⁃related stroke. Methods A total of 345 patients with BAD⁃related stroke were enrolled from June 2021 to June 2023 in the multicenter prospective cohort study (BAD⁃study) involving 20 comprehensive stroke centers across China. Neurological functional outcome at 90 d was assessed by modified Rankin Scale (mRS). Univariate and multivariate Logistic regression analyses were performed to identify factors influencing 90 d excellent outcome. Results Multivariate Logistic regression analysis showed that a daily average intake of < 2000 ml (OR=0.345, 95%CI:0.133-0.897; P=0.029), a daily average net intake of > 500 ml (OR=0.457, 95%CI:0.222-0.940; P=0.033), advanced age (OR=0.961, 95%CI: 0.929-0.994; P=0.021), diabetes mellitus (OR=0.494, 95%CI:0.245-0.995; P=0.048), previous statin use (OR=0.159, 95%CI:0.037-0.684; P=0.014), higher baseline National Institutes of Health Stroke Scale (NIHSS) score (OR=0.688, 95%CI:0.613-0.772; P=0.000), anticoagulant therapy (OR=0.416, 95%CI:0.203-0.850; P=0.016) and early neurological deterioration (OR=0.142, 95%CI:0.059-0.343; P=0.000) were risk factors for failture to achieve excellent outcome. Conclusions net intake of 0-500 ml in the acute⁃phase may have a better prognosis, suggesting that acute⁃phase volume management should balance the dual goals of avoiding hypovolemia and preventing volume overload, with individualized fluid rehydration strategies.