Prevalence and Prognostic Significance of Malnutrition Risk in Patients With Acute Ischemic Stroke: Results From the Third China National Stroke Registry

Abstract

Background and Purpose: To investigate the prevalence of malnutrition risk in patients with acute ischemic stroke (AIS) at admission, the association between malnutrition risk and long-term outcomes, and whether the predictive ability would be improved after adding to previous prognostic models for poor outcomes. Methods: Based on the Third China National Stroke Registry data from August 2015 to March 2018, we evaluated malnutrition risk using objective scores, including the controlling nutritional status score, geriatric nutritional risk index, and prognostic nutritional index. The primary outcome was death or major disability (modified Rankin Scale score ≥3) at 1 year after stroke onset. We calculated the crude prevalence of malnutrition risk and investigated the association between malnutrition risk and clinical outcomes. Prognostic performance of 3 objective malnutrition scores for poor outcomes was assessed. Results: Moderate to severe malnutrition risk was identified in 5.89%, 5.30%, and 1.95% of the Third China National Stroke Registry AIS patients according to the controlling nutritional status score, geriatric nutritional risk index, and prognostic nutritional index, respectively. At 1-year follow-up, 1143 participants (13.5%) experienced death or major disability. After adjustment for traditional risk factors, moderate to severe malnutrition risk was associated with high risk of composite events (odds ratio, 2.25 [95% CI, 1.75–2.90], for controlling nutritional status score; odds ratio, 2.10 [95% CI, 1.63–2.69], for geriatric nutritional risk index; odds ratio, 3.36 [95% CI, 2.33–4.84], for prognostic nutritional index; all P <0.01). Addition of the 3 malnutrition scores to different predicted scales (iScore and Acute Stroke Registry and Analysis of Lausanne) improved predictive ability for long-term poor outcomes validated by the integrated discrimination index (all P <0.05). Conclusions: The prevalence of moderate or severe malnutrition risk in Chinese patients with AIS ranged from 1.95% to 5.89%. Malnutrition risk in patients with AIS was associated with increased risk of long-term death and major disability. Our study provides evidence supporting the prognostic significance of objective malnutrition scores after AIS.

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

“…Moreover, the incidence of moderate to severe malnutrition risk ranged from 7.0 to 33.7%. The prevalence of moderate to severe malnutrition in this cohort was higher than that previously demonstrated in Third China National Stroke Registry ( Zhang et al, 2021 ) and a hospital-based retrospective study in Japan ( Naito et al, 2020 ), as well as similar to that reported in Nanjing Stroke Registry Program ( Yuan et al, 2021 ). This discrepancy of variation in malnutrition prevalence may be attributed to the difference in nutritional screening tools, timing, and populations.…”

“…Several objective nutritional tools were performed for evaluating malnutrition risk, including the controlling nutritional status (CONUT) score ( Ignacio de Ulíbarri et al, 2005 ), geriatric nutritional risk index (GNRI) ( Bouillanne et al, 2005 ), and prognostic nutritional index (PNI) ( Buzby et al, 1980 ). Recently, the three malnutrition scores, which can be easily calculated from objective variables, have been validated in predicting the prognosis of cardiovascular diseases and ischemic stroke ( Raposeiras Roubín et al, 2020 ; Yuan et al, 2021 ; Zhang et al, 2021 ). Using the three objective malnutrition indexes, data from Third China National Stroke Registry found that malnutrition risk in ischemic stroke patients was linked to a higher risk of long-term death and major disability ( Zhang et al, 2021 ).…”

“…Recently, the three malnutrition scores, which can be easily calculated from objective variables, have been validated in predicting the prognosis of cardiovascular diseases and ischemic stroke ( Raposeiras Roubín et al, 2020 ; Yuan et al, 2021 ; Zhang et al, 2021 ). Using the three objective malnutrition indexes, data from Third China National Stroke Registry found that malnutrition risk in ischemic stroke patients was linked to a higher risk of long-term death and major disability ( Zhang et al, 2021 ). However, the prognostic value of nutritional status on mortality in patients treated with IVT has not been adequately addressed.…”

Malnutrition and the Risk of Early Neurological Deterioration in Elderly Patients with Acute Ischemic Stroke

“…27 Zhang et al reported that 1.95-5.89% of patients with acute ischemic stroke had a moderate to severe malnutrition risk. 28 Due to the inclusion criterion of the elderly population only, the proportion of END (33.2%) and moderate to severe malnutrition risk (4.6-21.4%) in our study were higher than in previous reports.…”

“…Zhang et al performed a nationwide study and found that malnutrition was associated with long-term mobility and mortality in acute ischemic stroke. 28 The FOOD trial proved that ischemic stroke patients who were malnourished at admission had poor six-month prognoses. 29 It is recommended that enteral diets, nutritional supplements, and nasogastric tubes should be supplied for patients with malnutrition or those at malnutrition risk.…”