Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.Z., Y.P., R.Z., X.M., Z.L., H.L., Yilong Wang, X.Z., G.L., Yongjun Wang), Capital Medical University, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China (Y.P., R.Z., M.W., X.M., Z.L., H.L., Yilong Wang, X.Z., G.L., Yongjun Wang).
Stroke. 2022 Jan;53(1):111-119. doi: 10.1161/STROKEAHA.121.034366. Epub 2021 Oct 14.
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.
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.
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 <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 <0.05).
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.
本研究旨在调查急性缺血性脑卒中（AIS）患者入院时的营养风险发生率，探讨营养风险与长期预后的关系，以及在添加到以前的不良预后预测模型后，其对预测能力的改善情况。
本研究基于 2015 年 8 月至 2018 年 3 月的中国第三次国家卒中登记研究数据，使用客观评分（包括控制营养状态评分、老年营养风险指数和预后营养指数）评估营养风险。主要结局为卒中发病后 1 年时的死亡或主要残疾（改良 Rankin 量表评分≥3 分）。我们计算了营养风险的粗患病率，并探讨了营养风险与临床结局之间的关系。评估了 3 种客观营养评分对不良结局的预测性能。
根据控制营养状态评分、老年营养风险指数和预后营养指数，中国第三次国家卒中登记研究 AIS 患者中分别有 5.89%、5.30%和 1.95%的患者存在中重度营养风险。在 1 年随访时，有 1143 名（13.5%）参与者发生死亡或主要残疾。在调整传统危险因素后，中重度营养风险与复合事件的高风险相关（比值比，2.25[95%可信区间，1.75-2.90]，控制营养状态评分；比值比，2.10[95%可信区间，1.63-2.69]，老年营养风险指数；比值比，3.36[95%可信区间，2.33-4.84]，预后营养指数；均<0.01）。将 3 种营养评分添加到不同的预测量表（iScore 和急性卒中登记和洛桑分析）中，通过整合鉴别指数（均<0.05）验证了对长期不良结局的预测能力得到了提高。
中国 AIS 患者的中重度营养风险发生率为 1.95%-5.89%。AIS 患者的营养风险与长期死亡和主要残疾风险增加相关。本研究为 AIS 后客观营养评分的预后意义提供了证据支持。
