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J Stroke Cerebrovasc Dis. 2015 Dec;24(12):2720-7. doi: 10.1016/j.jstrokecerebrovasdis.2015.08.002. Epub 2015 Aug 31.

Preliminary Prospective Study to Assess the Effect of Early Blood Urea Nitrogen/Creatinine Ratio-Based Hydration Therapy on Poststroke Infection Rate and Length of Stay in Acute Ischemic Stroke.

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Department of Emergency Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Chiayi, Taiwan.
Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan.
Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan. Electronic address:



This study aimed to determine whether blood urea nitrogen (BUN)/creatinine (Cr)-based hydration therapy can decrease the rate of poststroke infection and length of stay (LOS) in the neurology ward.


This was a nonblinded, phase II single-arm prospective study with a historical control group of patients with acute ischemic stroke and a BUN/Cr ratio of 15 or higher. The study group (n = 134) received an intravenous saline bolus (300-500 mL) followed by maintenance saline (40-80 mL/hour) for the first 72 hours. The control group (n = 103) received maintenance saline infusions (40-60 mL/hour for the first 24 hours and 0-60 mL/hour for the next 24-72 hours).


The hydration group had a significantly lower poststroke infection rate than did the control group (7.5% versus 17.5%, P = .018) and significantly shorter LOS in the neurology ward (13.5 ± 11.6 versus 19.6 ± 14.6 days, P < .01). With regard to adverse events, two patients in each group had cerebral edema.


The findings suggest that the BUN/Cr ratio needs to be corrected in a timely manner in patients with acute ischemic stroke. Providing prompt saline hydration therapy based on the daily BUN/Cr ratio might decrease the poststroke infection rate and shorten LOS.


Blood urea nitrogen; acute ischemic stroke; creatinine; dehydration; hydration therapy; infection; length of stay

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