Sichuan University
West China Medical College

Presenter of 1 Presentation

OPTIMIZED TREATMENT SCHEDULE OF MANNITOL FOR SEVERE ISCHEMIC STROKE OR MASSIVE CEREBRAL INFARCTION: A PROPENSITY SCORE-MATCHED,PROSPECTIVE MULTI-CENTER COHORT STUDY

Session Type
Free Communication Session
Date
29.10.2021, Friday
Session Time
10:00 - 11:30
Room
FREE COMMUNICATIONS B
Presenter
Lecture Time
10:30 - 10:40

Abstract

Background and Aims

Patients with severe/massive ischemic stroke (SMIS) are prone to brain edema, even malignant brain edema, which is a major cause of are disability and mortality. Mannitol is widely used to treat brain edema in clinical practice, but its evidence is limited. Furthermore, the optimal timing, dosage, and duration of mannitol are unknown.

Methods

We performed a multi-center, prospective cohort study from July 2017 to September 2019. Patients (age ≥ 18 years) with SMIS who had used mannitol were eligible for inclusion. Patients with pre-morbid MRS>2 were excluded. Patients were stratified on the basis of the treatment schedule of mannitol they had received. Patients were matched on the basis of demographics, past medical history, etc. using PSM. The endpoints were 3-month outcomes and complications. Univariate analysis was performed to compare outcomes.

Results

401 patients were included (age: 70.9 ± 13.5 and 53.1% male). The median duration was 8 days [(IQR): 4-14 days]. The median daily average dose was 75g/day (IQR: 50-95g/day). Patients with early action use of mannitol were not associated with 3-month mRS 3-6 (OR=1.084, P=0.858), increased risk of acute kidney injury (OR=1.909, P=0.063), small-dose group associated with reduced risk of 3-month mRS 3-6 (OR=0.423, P=0.085) and reduced risk of acute kidney injury (OR=0.408, P=0.017). Short-term use of mannitol was not associated with 3-month mRS 3-6 and complications.

Conclusions

This study indicated that within 6-hours, low dose and 1-week course may be a better strategy to improve the 3-month outcomes and reduce the complications of mannitol for patients with severe /massive ischemic stroke.

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