Department of Geriatrics, Lishui Second People's Hospital, Lishui, Zhejiang, China.
Eur Rev Med Pharmacol Sci. 2023 Jun;27(12):5803-5811. doi: 10.26355/eurrev_202306_32819.
The aim of this study was to document the association between malnutrition and mortality as well as functional outcomes in patients with stroke.
PubMed, Embase and Scopus databases were systematically searched for observational studies that had used either of the three nutritional indices, geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), and controlling nutritional status score (CONUT), and examined the association between malnutrition and outcomes of interest in patients with stroke. The primary outcome was mortality and secondary outcomes were risk of recurrence and functional disability. Analysis was performed using STATA 16.0 software (College Station, TX, USA) and pooled effect sizes were reported as either hazards ratio (HR) or as odds ratio (OR). Random effects model was used for the analysis.
A total of 20 studies were included, of which, 15 were focused on acute ischemic stroke (AIS) patients. Among patients with AIS, moderate to severe malnutrition, assessed using CONUT (OR 4.80, 95% CI: 2.31, 9.98), GNRI (OR 3.57, 95% CI: 2.08, 6.12) and PNI (OR 8.10, 95% CI: 4.69, 14.0), was associated with increased risk of mortality within 3 months and at 1-year follow-up (CONUT: OR 2.74, 95% CI: 1.96, 3.83; GNRI: OR 2.26, 95% CI: 1.34, 3.81; PNI: OR 3.32, 95% CI: 2.24, 4.93). Patients with moderate to severe malnutrition, assessed using any of the three indices, had an increased risk of having an unfavourable outcome [modified Rankin Score (mRS) score of 3 to 6, denoting major disability and/or death] within 3 months and at 1-year follow-up. Only one study reported the risk of recurrence.
Assessing malnutrition in stroke patients at the time of hospital admission using any of the three nutritional indices is useful due to the observed association of malnutrition with survival and functional outcomes. However, due to a limited number of studies, there is a need for large prospective studies to validate the findings observed in this meta-analysis.
本研究旨在记录营养不良与卒中患者的死亡率和功能结局之间的关联。
系统检索了 PubMed、Embase 和 Scopus 数据库中使用三种营养指数（老年营养风险指数（GNRI）、预后营养指数（PNI）和控制营养状况评分（CONUT）中的任何一种评估卒中患者营养状况与预后相关性的观察性研究。主要结局为死亡率，次要结局为复发风险和功能障碍。采用 STATA 16.0 软件（美国得克萨斯州科林斯顿）进行分析，汇总效应大小以风险比（HR）或比值比（OR）表示。采用随机效应模型进行分析。
共纳入 20 项研究，其中 15 项专注于急性缺血性卒中（AIS）患者。在 AIS 患者中，使用 CONUT（OR 4.80，95%CI：2.31，9.98）、GNRI（OR 3.57，95%CI：2.08，6.12）和 PNI（OR 8.10，95%CI：4.69，14.0）评估的中重度营养不良与 3 个月和 1 年随访时的死亡率升高相关（CONUT：OR 2.74，95%CI：1.96，3.83；GNRI：OR 2.26，95%CI：1.34，3.81；PNI：OR 3.32，95%CI：2.24，4.93）。使用三种指数中的任何一种评估中重度营养不良的患者，在 3 个月和 1 年随访时发生不良结局（改良 Rankin 量表评分 3-6 分，提示严重残疾和/或死亡）的风险增加。仅有一项研究报告了复发风险。
在卒中患者入院时使用三种营养指数中的任何一种评估营养不良，有助于观察营养不良与生存和功能结局之间的关联。但是，由于研究数量有限，需要进行大型前瞻性研究来验证本荟萃分析中的发现。
