Association of body water balance, nutritional risk, and sarcopenia with outcome in patients with acute ischemic stroke

Abstract

Background: Bioelectrical impedance analysis (BIA) can serve to evaluate body water balance and muscle mass. The present study aimed to explore the interrelationships among body water balance, nutritional risk, sarcopenia, and outcome after acute ischemic stroke (AIS). Methods: This single-center, prospective study included 111 patients with AIS and a premorbid modified Rankin Scale score (mRS) ?2. Overhydration, indicating a body water balance abnormality, was defined as an extracellular fluid/total body water ratio >0.390. The geriatric nutritional risk index (GNRI) was used as nutrition marker, a GNRI <92 was considered low. Sarcopenia was defined according to the 2019 Asian Working Group for Sarcopenia criteria. Poor outcome was defined as an mRS ?3 at discharge. Results: In the overall cohort, including 40 women, the median age was 77 years, 43 had poor prognosis, 31 overhydration, 25 low GNRI, and 44 sarcopenia. Patients with poor outcome had significantly higher National Institutes of Health Stroke Scale (NIHSS) scores, and significantly more common with overhydration, low GNRI, and sarcopenia (P <0.001 for all). Increasing concomitance of overhydration, low GNRI, and sarcopenia was associated with a heightened rate of poor outcomes. Especially, poor outcome was observed in 19 of 23 patients with low muscle mass and overhydration. In multivariate analysis, overhydration (odds ratio [OR] 5.504, 95% confidence interval [CI] 1.717–17.648, P = 0.004), age (OR 1.062, 95%CI 1.010–1.117, P = 0.020) and NIHSS score (OR 1.790, 95%CI 1.307–2.451, P < 0.001) were independent poor prognostic factors. Conclusions: Body water balance and muscle mass assessment using BIA was useful in predicting AIS outcome. Overhydration was particularly associated with poor outcome. The combination of overhydration and low muscle mass could specifically predict poor outcomes after AIS.