Influence of nutritional status on clinical outcome after acute stroke

Abstract

A cause-and-effect relation between protein-energy malnutrition and poor outcome in acute stroke patients has not been definitively established. To measure the effect of the nutritional status of hospitalized stroke patients on clinical outcome, a prospective, observational study was performed. Acute stroke patients admitted to Leicester General Hospital from June 1994 to October 1995 had their nutritional status assessed with anthropometric, hematologic, and biochemical methods within 48 h of admission and after 2 and 4 wk. Outcome measures including disability, handicap, length of stay, morbidity (infective complications), discharge destination, and mortality were recorded during the hospital stay and at 3 mo. Nutritional status deteriorated significantly during the study period, but only serum albumin concentrations showed a significant association with various outcome measures. Stroke patients with hypoalbuminemia had a greater risk of infective complications (P<0.0001) and poor functional outcome during hospitalization than those with normal or higher serum albumin concentrations. Serum albumin concentrations were good predictors of the degree of disability and handicap during the hospital stay. After prognostic indicators of poor outcome were adjusted for, serum albumin concentration in the hospital was a strong and independent predictor of mortality at 3 mo after acute stroke [hazard ratio 0.91 (95% CI: 0.84, 0.99) for a 1-g/L higher serum albumin concentration]. Whether nutritional supplementation removes or mitigates the hazard of poor outcome associated with undernutrition after acute stroke needs to be determined.

Hypoalbuminemia in acute ischemic stroke patients: frequency and correlates

“…Serum albumin level was measured within 24 h after stroke onset, and hypoalbuminemia (serum albumin level o35 g/l) was observed in 7.7% of patients. Gariballa et al (1998) found serum albumin concentration o35 g/l in 19% from 201 ischemic stroke patients. In that study, serum albumin level was measured within 48 h after stroke onset.…”

“…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).…”

Serum Albumin Level and Short-Term Outcome Following Stroke in Hospital Admitted Patients

“…Many conditions such as malnutrition, liver and kidney diseases may reduce serum albumin concentrations. The catabolic state and the associated neuro-endocrine response that is likely to follow an acute stroke may lead to altered serum albumin concentration and there is recent evidence linking the high stress reaction after stroke and under-nutrition 12 .…”

“…In clinical practice serum albumin is often considered as a marker of nutritional status and a negative phase protein that decreases in concentration during injury and sepsis 8 . Serum albumin has neuroprotective effect that is mediated by its multitude of actions including anti-oxidant properties, modulation of endothelial functions and venular perfusion 9 .…”

Protein–energy malnutrition increases activation of the transcription factor, nuclear factor κB, in the gerbil hippocampus following global ischemia☆

“…[16]). Although most clinical studies addressing the impact of PEM on stroke outcome are limited by small sample size and study design, correlations have been drawn between PEM at stroke admission and increased risk of morbidity and mortality [17,18]. A definitive answer was expected from three large Feed or Ordinary Diet Collaboration Trials [19][20][21].…”