Malnutrition and Risk of Mortality in Ischemic Stroke Patients Treated With Intravenous Thrombolysis

Abstract

Background and PurposeMalnutrition is highly prevalent in ischemic stroke patients. We aimed to investigate whether malnutrition indexes may be useful in predicting mortality at 90 days in ischemic stroke patients treated with intravenous thrombolysis.MethodsWe retrospectively analyzed consecutive patients who underwent thrombolytic therapy at three comprehensive stroke centers. Malnutrition was assessed using the controlling nutritional status (CONUT) score, geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI).ResultsOf 979 patients (mean age, 66.8 years; males, 63.6%) included in this study, 91 (9.3%; 95% confidence interval [CI]: 8.4–10.2%) died at 3-month follow up. According to the CONUT, GNRI, and PNI scores, 9.9, 33.7, and 7.0% of patients were moderately or severely malnourished, respectively; 64.0% were at least mildly malnourished by at least 1 malnutrition index. In the multivariate regression model after adjusting for potential confounders, malnutrition (severe risk versus normal nutritional status) was significantly associated with an increased risk of mortality for CONUT scores (adjusted odds ratio [OR] 16.16, 95%CI, 7.86-67.11; P < 0.001), GNRI scores (adjusted OR 9.82, 4.10-23.51; P < 0.001) and PNI scores (adjusted OR 12.74, 5.56-29.19; P < 0.001). Similar results were found when the malnutrition scores were analyzed as continuous variables. Adding the three malnutrition indexes to models containing conventional risk factors significantly improved risk reclassification for 3-month mortality.ConclusionOur study showed that malnutrition may be associated with a higher risk of mortality at 3 months in ischemic stroke after intravenous thrombolysis.

Geriatric Nutritional Risk Index and the Prognosis of Patients with Stroke: A Meta-Analysis

“…Currently, no consensus has been reached regarding the optimal tools for the evaluation of nutritional status in patients with stroke. Three of the included studies showed that malnutrition evaluated by the controlling nutritional status score (CONUT), the prognostic nutritional index score (PNI), and the GNRI were all associated with significantly increased risk for mortality in adult patients after stroke [22,24,25]. However, the predictive efficacies among CONUT, PNI, and GNRI for the clinical outcomes in patients with stroke have not been directly compared.…”

“…Overall, five prospective [19,[21][22][23]25] and three retrospective [18,20,24] cohort studies from Japan, Korea, and China involving 13573 patients with stroke were included in this meta-analysis. All of the studies included patients with IS except for two studies, which included patients with IS and HS [18,21].…”

“…The mean ages of the patients varied between 62 and 77 years, and the proportions of men ranged from 57 to 69 %. The cutoffs for GNRI varied among the included studies, and four studies provided independent data-sets according to the severity of the GNRI-defined malnutrition [19,22,24,25]. The mean follow-up durations varied from one to 56 months.…”

“…However, previous studies evaluating the potential association between GNRI and the prognosis of patients with stroke showed inconsistent results 18 19 20 21 22 23 24 25 . Some studies suggested that a low GNRI was associated with poor functional outcome of increased mortality risk in these patients 18 19 22 24 25 , while the other studies did not 20 21 23 . Therefore, in this study, we performed a meta-analysis to comprehensively evaluate the potential role of GNRI as a predictor of prognosis of patients with stroke.…”

“…Moreover, malnutrition evidenced by low GNRI has been validated as a reliable prognostic factor for people with various clinical conditions, such as people admitted to a geriatric rehabilitation care unit [9], patients of heart failure [14], respiratory failure [15], and cancer [16] and the patients after emergency surgeries [17]. However, previous studies evaluating the potential association between GNRI and the prognosis of patients with stroke showed inconsistent results [18][19][20][21][22][23][24][25]. Some studies suggested that a low GNRI was associated with poor functional outcome of increased mortality risk in these patients [18,19,22,24,25], while the other studies did not [20,21,23].…”