Objective :
To investigate a prognostic role of malnutrition for inpatients with stroke, as assessed by the controlling nutritional status score (CONUT) which includes the serum albumin, total cholesterol level, and total lymphocyte count.
Method :
We retrospectively recruited 239 adult patients with the first-ever stroke during the period of March, 2017 through February, 2020. The inclusion criteria were as follows: 1) admission within 24 hours from symptom onset; 2) transfer to rehabilitation within 90 days and 3) admission routine blood sampling for laboratory tests performed within 24 hours. Of this group, 107 with missing data were excluded. Of the remaining 132 patients, 15 were excluded because of previous statin use, recent any infection and surgical intervention, leaving 117 patients was available for analysis.
Clinical and functional parameters were recorded by medical records including demographics, hypertension(HTN), diabetes mellitus(DM), atrial fibrillation(AF), days from transfer to rehabilitation, serological measurements (serum protein, albumin, and cholesterol, Hb and total lymphocyte counts ), a National Institutes of Health Stroke Scale score (NIHSS), Korean version of the Mini-Mental Status Examination (K-MMSE), the Berg balance scale (BBS) and functional independence measure (FIM) score. FIM motor and BBS effectiveness were calculated as (1month follow up - admission score). The association between CONUT score and the functional outcomes was investigated using multivariable logistic regression analysis with backward stepwise selection (P>.1 for exclusion).
Results :
Table 1 showed the baseline characteristics of the patients stratified by the combined outcome of transfer to rehabilitation and by CONUT categories. We identified independent predictors of the outcomes of interest among age, HTN, DM, AF, time from stroke onset to rehabilitation admission, dysphagia, NIHSS and BMI. After adjusting for independent predictors, CONUT score was associated with FIM motor and BBS effectiveness. (Table 2). Figure 2 shows mean proportional recovery across categories of CONUT score.
Conclusion :
This results show that pre-stroke malnutrition level as assessed with CONUT has a significant relationships with post-stroke functional outcome. This comprehensive and feasible marker of nutritional status might provide information to predict improvement of the clinical outcomes.
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Table 1. Baseline Characteristics Stratified by Outcome and Nutritional Scores
Table 2. Multiple Linear Regression Analysis with Backward Stepwise Selection Showing the Association of CONUT Score and the Functional Outcomes (n=117)
Fig. 1. Mean Proportional Recovery across Categories of the CONUT. The bars represent standard errors CONUT: controlling nutritional status, FIM: Functional independence measure, BBS: Berg balance scale
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