Undernutrition as a predictor of poor clinical outcomes in acute ischemic stroke patients

Abstract

Objective: To determine whether changes in nutritional status in the first week after acute ischemic stroke and undernutrition predicts poor clinical outcomes.

Design: Prospective observational study.

Setting: Tertiary university hospital.

Patients: We included 131 acute ischemic stroke patients who underwent nutritional assessments within 24 hours and at 1 week after symptom onset.

Main outcome measures: Undernutrition was diagnosed when 1 or more of the following 5 parameters were present: (1) weight loss 10% or more during the past 3 months or 6% or more during the week after admission, (2) a weight index less than 80%, (3) a serum albumin level less than 3.0 g/dL, (4) a transferrin level less than 150 mg/dL, or (5) a prealbumin level less than 10 mg/dL. We assessed poststroke complications and 3-month outcome using modified Rankin Scale responder analysis.

Results: Of 131 patients included in this study, undernutrition was observed in 16 (12.2%) patients at admission and in 26 (19.8%) at 1 week. Multiple logistic regression analysis showed that baseline undernutrition independently predicted 1-week undernutrition (odds ratio [OR], 14.85; 95% confidence interval [CI], 3.52-62.76; P< .001) and poststroke complications (OR, 6.72; 95% CI, 1.09-41.56; P= .04), and that 1-week undernutrition (OR, 4.49; 95% CI, 1.07-18.94; P= .04) and 1-week National Institutes of Health Stroke Scale score (OR, 1.76; 95% CI, 1.31-2.37; P< .001) independently predicted poor 3-month outcomes.

Conclusions: These findings suggest that acute ischemic stroke patients with baseline undernutrition are being undernourished during hospitalization. Strategic nutritional support, particularly in patients with baseline undernutrition, may improve clinical outcomes.