Understanding hydration and stroke outcomes in Zambia

了解赞比亚的水合作用和中风结果

• 批准号: 10053462
• 负责人: Mona N Bahouth
• 金额: $ 18.51万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10053462
• 关键词: Acute; Admission activity; Adult; Africa South of the Sahara; Benefits and Risks; Blood Circulation; Blood Urea Nitrogen; Blood Viscosity; Brain; Brain Edema; Caring; Cause of Death; Cerebral Malaria; Cerebrum; Cessation of life; Child; Childhood; Clinical; Clinical Research; Clinical Trials; Contracts; Country; Creatinine; Data; Dehydration; Environment; Focus Groups; Foundations; Frequencies; Future; Goals; Group Interviews; Guidelines; Health Personnel; Heart failure; Heterogeneity; Hospital Mortality; Hospital Referrals; Hospitals; Hydration status; IV Fluid; Individual; International; Intervention; Interview; Ischemic Stroke; Knowledge; Laboratory Markers; Language; Length of Stay; Light; Link; Malaria; Measures; Morbidity - disease rate; Neurology; Outcome; Outcome Study; Participant; Patient Care; Patient-Focused Outcomes; Patients; Perception; Perfusion; Physicians; Pilot Projects; Population; Protocols documentation; Rehydrations; Research; Resources; Risk; Sampling; Sepsis; Severities; Shoulder; Standardization; Stroke; Structure; System; Teaching Hospitals; Telephone; Testing; Time; Translating; United States; United States National Institutes of Health; Universities; Validity and Reliability; Work; Zambia; base; clinically relevant; comorbidity; disability; functional disability; functional outcomes; improved; low and middle-income countries; mortality; neuroimaging; pediatric patients; post stroke; prospective; standard of care; stroke outcome; stroke patient; stroke therapy; tool; treatment guidelines

PROJECT SUMMARY A large percentage of patients are dehydrated (more accurately, in a volume contracted state) at the time of stroke, and there is accumulating evidence that these patients do not recover as well as patients who are not dehydrated. Although administering more intravenous fluids may benefit these patients by increasing circulation to the brain, clinicians are often cautious in light of the risks for heart failure and brain swelling which are common after stroke. Application of US guidelines about rehydration strategies after stroke may not be appropriate seen in prior studies of rehydration in pediatric patients with malaria. Furthermore, no information exists about stroke patients with varying comorbid conditions in low and middle income countries like those in sub-Saharan Africa. In order to advance our knowledge, we need to understand the hydration status of stroke patients in Zambia, explore physician perspectives about rehydration in the early stroke period and create regionally appropriate tools to measure stroke outcomes. In this proposal, we seek to demonstrate that simple and broadly available laboratory markers are capable of quantifying a patient’s volume status at the time of stroke and to explore the relationship between volume status and stroke outcomes using tools adapted for use in local Zambian languages. We will additionally conduct focus group interviews with physicians to understand perspectives and current practices in Zambia. Stroke patients from a single hospital in Zambia will have baseline lab testing to assess for dehydration and quantification of stroke severity and functional outcomes over thirty days. We anticipate that the study will establish the clinical relevance of a surrogate composite of labs to identify dehydration in the early stroke period and explore the connection to stroke outcomes in this population. If dehydration is associated with worsened outcomes after stroke, this research will provide the foundation for implementation of a scalable rehydration intervention in future clinical trials. The long-term goal of this study team is to identify potential interventions to improve morbidity and mortality after stroke that are applicable in both resource-rich and resource-limited settings. This research will provide critical data about dehydration and stroke in sub-Saharan Africa, help establish a sustainable system for clinical research and stroke care in Zambia, and inform a future international trial of rehydration after stroke. Given the high stroke rates and projections that stroke burden in sub-Saharan Africa will continue to substantially increase in coming years, interventions are urgently needed to improve patient outcomes in these countries. Such an intervention should be scalable and feasible to administer in non-tertiary settings, with minimal resources, and by non-physician healthcare workers. Emerging evidence indicates that early rehydration after stroke could be such an intervention.

项目总结