Association between Geriatric Nutritional Risk Index and Post-Stroke Cognitive Outcomes

Abstract

Background: It is not yet clear whether nutritional status is associated with post-stroke cognitive impairment (PSCI). We examined the geriatric nutritional risk index (GNRI) on the domain-specific cognitive outcomes 3 months after a stroke. Methods: A total of 344 patients with acute ischemic stroke were included for the analysis. The GNRI was calculated as 1.489 × serum albumin (g/L) + 41.7 × admission weight (kg)/ideal body weight (kg) and was dichotomized according to the prespecified cut-off points for no risk and any risks. The primary outcome was PSCI, defined as having adjusted z-scores of less than −2 standard deviations in at least one cognitive domain: executive/activation, memory, visuospatial and language. Multiple logistic regression and linear regression analyses were performed to investigate the association between the GNRI and cognitive outcomes. Results: Seventy (20.3%) patients developed PSCI 3 months after a stroke. The mean GNRI was 106.1 ± 8.6, and 59 (17.2%) patients had low (<98) GNRI scores. A low GNRI was independently associated with the PSCI after adjusting for age, sex, education, initial stroke severity, stroke mechanism and left hemispheric lesion (odds ratio, 2.04; 95% confidence interval, 1.00–4.14). The GNRI scores were also significantly associated with the z-scores from the mini-mental status examination and the frontal domain (β = 0.04, p-value = 0.03; β = 0.03, p-value = 0.03, respectively). Conclusions: A low GNRI was independently associated with the development of PSCI at 3 months after an ischemic stroke. The GNRI scores were specifically associated with the z-scores of the global cognition and frontal domain cognitive outcomes.

Association between Geriatric Nutritional Risk Index and Depression after Ischemic Stroke

“…A Japanese study of 540 stroke patients, with a mean age of 80 years, showed that a low GNRI (<92) at baseline and predicted poorer functional outcomes, as represented by the functional independence measure (FIM) gain [32]. Moreover, a recent Korean study, based on 344 patients with stroke (mean age: 62 years), indicated that malnutrition (GNRI < 98) at admission was associated with a higher risk of post-stroke cognitive impairment (OR = 2.04) and lower scores in the specific cognitive domains of executive/activation and language [22]. Compared to MNA and MUST, which require completing structured questionnaires, the GNRI is more convenient to achieve [18].…”

“…Recently, several studies have validated the predictive value of the GNRI for clinical outcomes in patients with malignant, heart, and renal diseases and stroke [8,12,20,21]. Lee et al (2021) reported that lower GNRI scores were associated with a higher risk of post-stroke cognitive impairment [22] and lower cognitive scores in the Korean version of the mini-mental status examination and executive/activation domain. After stroke onset, cognitive impairment was highly correlated with depression at the same time point [23].…”

Geriatric Nutritional Risk Index is related to the risk of stroke‐associated pneumonia

“…This index can predict the complications induced by malnutrition as well (Cereda et al., 2009 ). Predictions of some diseases incidence and prognosis have been made through GNRI in earlier investigations, including postoperative survival rate of esophageal cancer (Kubo et al., 2019 ), postoperative complications of gastric cancer (Kushiyama et al., 2018 ), postoperative bleeding of the pancreas (Funamizu et al., 2020 ), mortality of heart failure (Li et al., 2021 ), the prognosis of coronavirus disease(COVID‐19) (Lidoriki et al., 2020 ; Recinella et al., 2020 ), and poststroke cognitive impairment (Lee et al., 2021 ). Besides, studies have also found that malnutrition can lead to complications such as decreased immunity and infection (Keusch, 2003 ).…”

Association between Geriatric Nutritional Risk Index and Invasive Candidiasis in Critical Care

“…Geriatric Nutritional Risk Index (GNRI) is a widelyaccepted objective scoring system to effectively and conveniently evaluate the nutritional status of geriatric patients, which is simply calculated by height, body weight, and serum albumin, three readily accessible indices [18]. Studies have proven that a lot of diseases or outcomes were signi cantly associated with GNRI, such as Post-Stroke Cognitive Outcomes, arrhythmia recurrence, heart failure, and frailty [19][20][21][22]. However, few studies have investigated whether GNRI is signi cantly and independently associated with invasive candidiasis.…”