Domenico Scrutinio1, Bernardo Lanzillo2, Pietro Guida3, Andrea Passantino3, Simona Spaccavento3, Petronilla Battista3. 1. Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S. Institute of Cassano Murge, Bari, Italy. Electronic address: domenico.scrutinio@icsmaugeri.it. 2. Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S. Institute of Telese Terme, Benevento, Italy. 3. Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S. Institute of Cassano Murge, Bari, Italy.
Abstract
OBJECTIVE: To investigate the incremental prognostic significance of malnutrition in patients with severe poststroke disability. DESIGN: Retrospective cohort study. The patients were recruited from 3 specialized inpatient rehabilitation facilities. Nutritional status was assessed using the Prognostic Nutritional Index (PNI), which is calculated from serum albumin and total lymphocyte count. Scores >38 points reflect normal nutrition status, scores of 35-38 indicate moderate malnutrition, and scores <35 indicate severe malnutrition. The association of PNI categories with outcomes was assessed using multivariable regression analyses. SETTING: Inpatient rehabilitation facility. PARTICIPANTS: Patients (N=668) with ischemic stroke admitted to inpatient rehabilitation within 90 days from stroke occurrence and classified as Case-Mix Groups 0108, 0109, and 0110 of the current Medicare case-mix classification system. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Three outcomes were examined: (1) the combined outcome of transfer to acute care and death within 90 days from admission to rehabilitation; (2) 2-year mortality; and (3) FIM motor effectiveness, calculated as (FIM motor change/maximum FIM motor-admission FIM motor score)×100. RESULTS: Overall, the median time to rehabilitation admission was 18 days (range, 12-26 days). The prevalence of moderate and severe malnutrition was 12.7% and 11.5%, respectively. Ninety-one patients (13.6%) experienced the combined outcome. After adjusting for independent predictors including sex, atrial fibrillation, dysphagia, FIM cognitive score, and hemoglobin levels, neither moderate (P=.280) nor severe malnutrition (P=.482) were associated with the combined outcome. Similar results were observed when looking at 2-year mortality. Overall, FIM motor effectiveness was 30%±24%. After adjusting for independent predictors, severe malnutrition (β coefficient -0.458±0.216; P=.034) was associated with FIM motor effectiveness. CONCLUSIONS: Approximately 1 in every 9 patients presented severe malnutrition. On top of the independent predictors, severe malnutrition did not provide additional prognostic information concerning risk of the combined outcome or 2-year mortality. Conversely, severe malnutrition was associated with poorer functional outcome as expressed by FIM motor effectiveness.
OBJECTIVE: To investigate the incremental prognostic significance of malnutrition in patients with severe poststroke disability. DESIGN: Retrospective cohort study. The patients were recruited from 3 specialized inpatient rehabilitation facilities. Nutritional status was assessed using the Prognostic Nutritional Index (PNI), which is calculated from serum albumin and total lymphocyte count. Scores >38 points reflect normal nutrition status, scores of 35-38 indicate moderate malnutrition, and scores <35 indicate severe malnutrition. The association of PNI categories with outcomes was assessed using multivariable regression analyses. SETTING: Inpatient rehabilitation facility. PARTICIPANTS: Patients (N=668) with ischemic stroke admitted to inpatient rehabilitation within 90 days from stroke occurrence and classified as Case-Mix Groups 0108, 0109, and 0110 of the current Medicare case-mix classification system. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Three outcomes were examined: (1) the combined outcome of transfer to acute care and death within 90 days from admission to rehabilitation; (2) 2-year mortality; and (3) FIM motor effectiveness, calculated as (FIM motor change/maximum FIM motor-admission FIM motor score)×100. RESULTS: Overall, the median time to rehabilitation admission was 18 days (range, 12-26 days). The prevalence of moderate and severe malnutrition was 12.7% and 11.5%, respectively. Ninety-one patients (13.6%) experienced the combined outcome. After adjusting for independent predictors including sex, atrial fibrillation, dysphagia, FIM cognitive score, and hemoglobin levels, neither moderate (P=.280) nor severe malnutrition (P=.482) were associated with the combined outcome. Similar results were observed when looking at 2-year mortality. Overall, FIM motor effectiveness was 30%±24%. After adjusting for independent predictors, severe malnutrition (β coefficient -0.458±0.216; P=.034) was associated with FIM motor effectiveness. CONCLUSIONS: Approximately 1 in every 9 patients presented severe malnutrition. On top of the independent predictors, severe malnutrition did not provide additional prognostic information concerning risk of the combined outcome or 2-year mortality. Conversely, severe malnutrition was associated with poorer functional outcome as expressed by FIM motor effectiveness.
Authors: Viviënne Huppertz; Sonia Guida; Anne Holdoway; Stefan Strilciuc; Laura Baijens; Jos M G A Schols; Ardy van Helvoort; Mirian Lansink; Dafin F Muresanu Journal: Front Neurol Date: 2022-02-01 Impact factor: 4.003
Authors: V A L Huppertz; W Pilz; G Pilz Da Cunha; L C P G M de Groot; A van Helvoort; J M G A Schols; L W J Baijens Journal: Front Neurol Date: 2022-09-28 Impact factor: 4.086