Undernutrition Predicts Poorer Clinical Outcomes in Ischemic Stroke

Caroline Cassels

January 17, 2008

To read this article for CME, click here.

January 17, 2008 — Patients hospitalized for acute ischemic stroke who are undernourished at admission are likely to remain so during their hospital stay, putting them at increase risk for poorer clinical outcomes, new research suggests.

In a prospective study of 131 ischemic stroke patients, investigators at the University of Ulsan College of Medicine, in Seoul, Korea, found undernutrition at baseline was associated with undernutrition 1 week later and complications immediately following stroke. In addition, undernutrition at 1 week predicted poorer outcomes at 3 months.

"Although undernutrition is common in medical, geriatric, and stroke patients, its treatment has received little attention. Because undernutrition may influence clinical outcomes, it is important to assess nutritional status and treat undernutrition, particularly during the acute stage of stroke," the authors write.

Led by Sung-Hee Yoo, the study is published in the January issue of Archives of Neurology.

According to the authors, several studies have shown undernutrition contributes to clinical outcomes, while others have shown no association. They speculate that part of the reason for these conflicting findings may be due to factors such as differing definitions of undernutrition and measurement of undernutrition at different time points following the event.

To determine whether there is a link between nutritional status and clinical outcomes, researchers assessed stroke patients within 24 hours of hospital admission and 1 week after symptom onset using 5 nutritional parameters:

  • Weight loss.

  • Weight index (measured as actual body weight in relation to reference weight).

  • Serum albumin level.

  • Serum transferrin level.

  • Serum prealbumin level.

The condition was diagnosed when 1 or more of these parameters indicated undernutrition. Nutritional changes after 1 week were categorized as no change, improved, or worsened.

Complications were assessed immediately after hospital admission and continuously until patients were discharged or transferred to a rehabilitation unit, and clinical outcomes were measured 3 months later.

Potential complications included pneumonia, myocardial infarction, urinary tract infection, extracranial hemorrhage, deep vein thrombosis, and pressure sores.

Long-term clinical outcome was assessed using the modified Rankin Scale (mRS) scoring at 3 months poststroke, with outcome categorized as good or poor according to responder analysis, which judges outcome based on baseline National Institutes of Health Stroke Scale (NIHSS) score.

Unpalatable Results

Of the total patient group, 16 (12.2%) subjects were undernourished at hospital admission. One week later, 26 (19.8%) patients were undernourished.

The study showed that baseline NIHSS score and baseline undernutrition were independent predictors of poststroke complications during hospitalization.

Furthermore, the investigators found 1-week undernutrition and 1-week NIHSS score were independent predictors of poor outcome at 3 months.

"These results suggest that patients undernourished at admission do not recover well with general hospital diets and are more likely to have poststroke complications and that undernourished patients during hospitalization are more likely to develop poor functional outcomes," the investigators write.

In an accompanying editorial, Neeraj Badjatia, MD, and Mitchell S.V. Elkind, MD, from Columbia University Medical Center, in New York, note that this study is the latest research to highlight the potential value of nutritional support in stroke patients in the acute care setting.

"Providing adequate caloric intake early in the course after ischemic stroke may now be seen as a therapeutic intervention used to minimize disease severity, reduce complications, and favorably affect patient outcomes. In the end, factors related to overall amount, content, route, and timing may determine whether nutritional support improves outcomes or is ineffective," they write.

The authors report no financial disclosures related to the study.

Arch Neurol. 2008;65:39-43 Abstract, 15-16. Abstract

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