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Original Contribution
January 2008

Undernutrition as a Predictor of Poor Clinical Outcomes in Acute Ischemic Stroke Patients

Author Affiliations

Author Affiliations: Department of Neurology (Ms Yoo and Drs Kim, Kwon, Koh, and Kang) and Division of Epidemiology and Biostatistics Clinical Research Center (Dr Yun), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Arch Neurol. 2008;65(1):39-43. doi:10.1001/archneurol.2007.12

Objective  To determine whether changes in nutritional status in the first week after acute ischemic stroke and undernutrition predicts poor clinical outcomes.

Design  Prospective observational study.

Setting  Tertiary university hospital.

Patients  We included 131 acute ischemic stroke patients who underwent nutritional assessments within 24 hours and at 1 week after symptom onset.

Main Outcome Measures  Undernutrition was diagnosed when 1 or more of the following 5 parameters were present: (1) weight loss 10% or more during the past 3 months or 6% or more during the week after admission, (2) a weight index less than 80%, (3) a serum albumin level less than 3.0 g/dL, (4) a transferrin level less than 150 mg/dL, or (5) a prealbumin level less than 10 mg/dL. We assessed poststroke complications and 3-month outcome using modified Rankin Scale responder analysis.

Results  Of 131 patients included in this study, undernutrition was observed in 16 (12.2%) patients at admission and in 26 (19.8%) at 1 week. Multiple logistic regression analysis showed that baseline undernutrition independently predicted 1-week undernutrition (odds ratio [OR], 14.85; 95% confidence interval [CI], 3.52-62.76; P < .001) and poststroke complications (OR, 6.72; 95% CI, 1.09-41.56; P = .04), and that 1-week undernutrition (OR, 4.49; 95% CI, 1.07-18.94; P = .04) and 1-week National Institutes of Health Stroke Scale score (OR, 1.76; 95% CI, 1.31-2.37; P < .001) independently predicted poor 3-month outcomes.

Conclusions  These findings suggest that acute ischemic stroke patients with baseline undernutrition are being undernourished during hospitalization. Strategic nutritional support, particularly in patients with baseline undernutrition, may improve clinical outcomes.