ORIGINAL RESEARCH ARTICLE
Treatment with Mannitol is Associated with Increased Risk for
In-Hospital Mortality in Patients with Acute Ischemic Stroke
and Cerebral Edema
Marianthi Papagianni
1
•
Konstantinos Tziomalos
1
•
Stavroula Kostaki
1
•
Stella-Maria Angelopoulou
1
•
Konstantinos Christou
1
•
Stella D. Bouziana
1
•
Maria Vergou
1
•
Triantafyllos Didangelos
1
•
Christos Savopoulos
1
•
Apostolos I. Hatzitolios
1
Ó Springer International Publishing AG, part of Springer Nature 2018
Abstract
Background Current guidelines state that osmotic therapy
is reasonable in patients with clinical deterioration from
cerebral infarction-related cerebral edema. However, there
are limited data on the safety and efficacy of this therapy.
We aimed to evaluate the effect of mannitol on the out-
come of ischemic stroke-related cerebral edema.
Methods and Results We prospectively studied 922 con-
secutive patients admitted with acute ischemic stroke.
Patients who showed space-occupying brain edema with
tissue shifts compressing the midline structures received
mannitol. The outcome was assessed with dependency
rates at discharge (modified Rankin Scale grade 2–5) and
in-hospital mortality. Rates of dependency were higher in
patients treated with mannitol (n = 86) than in those who
were not (97.7 and 58.5%, respectively; p \ 0.001). Inde-
pendent predictors of dependency were age, history of
ischemic stroke and National Institutes of Health Stroke
Scale (NIHSS) score at admission. Rates of mortality were
higher in patients treated with mannitol than in those who
were not (46.5 and 5.6%, respectively; p \ 0.001). Inde-
pendent predictors of in-hospital mortality were diastolic
blood pressure [relative risk (RR) 1.05, 95% confidence
interval (CI) 1.02–1.08, p \ 0.001], NIHSS score at
admission (RR 1.19, 95% CI 1.14–1.23, p \ 0.001) and
treatment with mannitol (RR 3.45, 95% CI 1.55–7.69,
p \ 0.005).
Conclusions Administration of mannitol to patients with
ischemic stroke-related cerebral edema does not appear to
affect the functional outcome and might increase mortality,
independently of stroke severity.
Key Points
In patients with cerebral edema due to acute
ischemic stroke, mannitol does not appear to affect
the functional outcome.
However, mannitol appears to increase the risk of
death in these patients.
This detrimental effect appears to be independent of
stroke severity.
1 Introduction
Stroke is a leading cause of mortality and long-term dis-
ability globally [1, 2]. Despite significant variations in the
burden of stroke in low- and high-income countries, both
the prevalence of stroke and stroke-related deaths have
increased in absolute numbers, particularly in the elderly
[3].
Brain edema is a well-described stroke complication and
is associated with poor outcome [4–7]. Cerebral edema
compromises cerebral perfusion and might also result in
compression of the midline structures, which might cul-
minate in transtentorial herniation [8]. Although decom-
pressive hemicraniectomy reduces mortality in patients
& Konstantinos Tziomalos
ktziomalos@yahoo.com
1
First Propedeutic Department of Internal Medicine, Medical
School, Aristotle University of Thessaloniki, AHEPA
Hospital, 1 Stilponos Kyriakidi Street, 54636 Thessaloniki,
Greece
Am J Cardiovasc Drugs
https://doi.org/10.1007/s40256-018-0285-0
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