Impact of Premorbid Undernutrition on Outcome in Stroke Patients

Abstract

Background and Purpose-To assess the prevalence of premorbid undernutrition and its impact on outcomes 1 month after stroke. Methods-The study recruited from consecutive stroke admissions during a 10-month period. Premorbid nutritional status (using the subjective global assessment [SGA]), premorbid functioning (modified Rankin scale [MRS]), and stroke severity (National Institutes of Health Stroke Scale [NIHSS] score) were assessed at admission. The associations between premorbid nutritional status, poor outcome (defined as MRS Ն3), and mortality were examined before and after adjustment for confounding variables, including age, gender, stroke risk factors, stroke severity, and admission serum albumin. Results-Thirty of 185 patients were assessed as having undernutrition at admission. Significant unadjusted associations were observed between undernutrition and poor outcome (odds ratio [OR], 3.4; 95% CI, 1.3 to 8.7; Pϭ0.01), and mortality (OR, 3.1, 95% CI, 1.3 to 7.7; Pϭ0.02) at 1 month. NIHSS, age, and premorbid MRS were also significantly associated with poor outcomes. After adjustment for these factors, the effect size of associations remained important but not significant (poor outcome: OR, 2.4; 95% CI, 0.7 to 9.0, Pϭ0.18; mortality: OR, 3.2; 95% CI, 1.0 to 10.4, Pϭ0.05). Conclusions-Premorbid undernutrition, as assessed using the SGA, appears to be an independent predictor of poor stroke outcome. Stroke prevention strategies should target undernutrition in the population at risk for stroke to improve outcomes.

Hypoalbuminemia in acute ischemic stroke patients: frequency and correlates

“…were excluded from the study. Davis et al (2004) measured serum albumin concentration in 185 patients with cerebral infarction and intracerebral hemorrhage within 24 h after stroke onset. They found hypoalbuminemia (serum albumin level p34 g/l) in 16.2% of patients.…”

“…Protein energy malnutrition affects 8-30% of stroke patients on admission (Cairella et al, 2004), and low serum albumin at admission is significantly associated with premorbid nutrition (Davis et al, 2004). …”

“…Hypoalbuminemia was reported in up to 19% of stroke patients (Davalos et al, 1996;Gariballa et al, 1998;Davis et al, 2004). Stroke patients with hypoalbuminemia at admission had increased risk of infective complications (Gariballa et al, 1998;Dziedzic et al, 2006), death (Gariballa et al, 1998;Davis et al, 2004) and poor functional outcome (Davalos et al, 1996;Gariballa et al, 1998).…”

Association of Nutrition Status and Rehabilitation Outcome in the Disuse Syndrome: a Retrospective Cohort Study

“…Rehabilitation outcome has been shown to be poor in malnourished patients with stroke, 4 chronic heart failure, 5 chronic obstructive pulmonary disease, 5 and a variety of other diseases. It has therefore been suggested the relationship between nutritional supplementation and rehabilitation from hospital-associated deconditioning is an important area of research.…”

Relationship between nutritional status and mortality during the first 2 weeks following treatment for cervical spinal cord injury

“…Malnutrition was diagnosed as serum albumin less than 35 g/l and serum prealbumin less than 250 mg/ l. 19,20 Hypoalbuminemia and malnutrition were treated on a case-by-case basis according to the hospital's management protocols, including nutritional support with a high-protein diet and supplementation with intravenous albumin.…”