Deans' stroke musings: Prognostic Nutritional Index for Predicting 3-Month Outcomes in Ischemic Stroke Patients Undergoing Thrombolysis

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, July 7, 2020

Prognostic Nutritional Index for Predicting 3-Month Outcomes in Ischemic Stroke Patients Undergoing Thrombolysis

Useless. Predictions help survivors not one bit. The stupid, it burns. And you have no suggestion on how to prevent this malnutrition problem.

Prognostic Nutritional Index for Predicting 3-Month Outcomes in Ischemic Stroke Patients Undergoing Thrombolysis

Weiwei Xiang¹^†,

Xiyi Chen²^†,

Weiyi Ye¹^†,

Jia Li¹,

Xu Zhang¹^* and

Dewei Xie¹^*

¹Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
²Department of Cardiovascular and Thoracic Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

Objective: Malnutrition has been reported to be related to adverse prognosis in acute ischemic stroke (AIS) patients. Unfortunately, traditional nutritional assessment tools usually increase the workload of neurologists, which makes them unfeasible in the daily clinic work. We aimed to elucidate the association between the prognostic nutritional index (PNI), an easily obtainable baseline nutritional marker, and 3-month outcomes in AIS patients receiving intravenous thrombolysis (IVT).

Research methods and procedures: The present study retrospectively included 405 patients. PNI was calculated as 5^*lymphocyte count (10⁹ /L) + serum albumin concentration (g/L), and the good prognosis was defined as modified Rankin Scale score of 0–3. The relationship between PNI and clinical parameters was evaluated. The multiple logistic regression model was performed to find out independent predictors of the 3-month outcomes.

Results: We found that the patients in the low PNI group had a higher frequency of anemia (12.9 vs. 2.3%, P < 0.001) and a higher level of the Controlling nutritional status (CONUT) score (P < 0.001). The relationship between PNI and nutrition-related factors, such as body mass index (r = 0.208, P = 0.001), age (r = −0.329, P < 0.001), total cholesterol (r = 0.268, P < 0.001) and hemoglobin concentration (r = 0.328, P < 0.001), was significant. Low PNI value (adjusted odds ratio: 2.250, confidence interval: 1.192–4.249, p = 0.012) stayed as an independent predictor for the poor outcome at three months, after adjustment for potential confounders.

Conclusions: The PNI was independently associated with 3-month outcomes in AIS patients undergoing IVT. As an easily obtainable nutritional marker, PNI may be a useful nutritional assessment tool in the clinic work.

Introduction

Malnutrition has been demonstrated to be correlated to poor prognosis in a variety of diseases, such as heart failure, malignant diseases as well as acute ischemic stroke (AIS) (1–5). Also, studies have shown that nutritional status at admission was independently associated with clinical outcomes in stroke patients (5). As early nutritional intervention would improve the life quality of malnourished patients, it is essential to assess nutritional status in patients with AIS (6).

It is not easy to evaluate the nutritional status of the patients. Many nutritional indicators are too subjective because they are either affected by the examiners' experience or obtained verbally from patients and their relatives. Moreover, collecting all the subjective information would inevitably increase the workload of routine clinical practice. As an objective nutritional marker, prognostic nutritional index (PNI) was easy to calculate using serum albumin concentration and lymphocyte count, which were routine detection index in the blood test. Thus, PNI is more feasible in the clinic work.

As far as we know, it is still unclear whether nutritional status assessed by PNI was useful for predicting the short-term clinical outcome in AIS patients. We believed that nutritional status on admission in AIS patients with intravenous thrombolysis (IVT) could better represent the baseline nutritional status. Because they have a short and relatively uniform onset-to admission time when compared to the AIS patients without IVT, the nutritional status of patients was less likely to be influenced by neurological dysfunction during such a short time. Therefore, we aimed to explore the prognostic significance of PNI in AIS patients receiving IVT in the present study.