Prognostic value of albumin-based malnutritional indices on short-term outcome in acute ischemic stroke patients undergoing reperfusion therapy

Prognostication DOES NOTHING TO GET SURVIVORS RECOVERED! Are you that blitheringly stupid that you think this research is good for anything? Creating a protocol to prevent this is what's needed! AND YOU COMPLETELY FAILED AT THAT!

This earlier research could have led you correctly but obviously you knew nothing about it!

albumin (5 posts to October 2011)

 Prognostic value of albumin-based malnutritional indices on short-term outcome in acute ischemic stroke patients undergoing reperfusion therapy

Junle Zhao^1†Mingjie Chen^1†Junning Mo^1†Yutong Zhong¹Jiamin Qiu¹Yanjiao Qiu¹Youjia Li^1*Xiaoyan Han^1,2*

• ¹Department of Neurology, First People’s Hospital of Zhaoqing, Zhaoqing, China
• ²Clinical Research Center, First People’s Hospital of Zhaoqing, Zhaoqing, China

Background: The malnutrition and inflammatory status are dependently associated with an increased risk of poor prognosis in patients with acute ischemic stroke (AIS). However, the evidence surrounding the prognostic significance of albumin-based malnutritional indices in AIS patients receiving reperfusion therapy remains insufficient. We aimed to explore prognostic value of the controlling nutritional status score (CONUT), prognostic nutritional index score (PNI), and neutrophil percentage-to-albumin ratio (NPAR) on short-term outcome of AIS patients undergoing reperfusion therapy.

Methods: A total of 612 AIS patients were enrolled. The association of the malnutritional indices and 3-months poor prognosis was accessed by multivariable logistics regression model. We further performed a logistic regression model with restricted cubic splines to examine the potential nonlinear correlations between the malnutritional indices and short-term poor prognosis. Subgroup analysis and reclassification indexes were also conducted to enhance the robustness of the findings. Additionally, mediation analyses were performed to examined the potential mediating effects of early neurological deterioration (END) presence on the associations of malnutrition with 3-months unfavorable outcomes.

Results: 256 patients developed poor prognosis at 3-month follow-up. Malnutrition was associated with the risk of 3-month poor functional outcome for CONUT (per 1-point increased, adjusted OR 1.59, 95%CI 1.40–1.82), for PNI (per 1-point increased, adjusted OR 0.86, 95%CI 0.82–0.90), and the NPAR (per 1-SD increased, adjusted OR 23.97, 95%CI 7.15–85.72). The PNI exhibited nonlinear association with the 3-month poor prognosis. These three indices in addition to other clinical risk factors improved the model discrimination. Compared to the NPAR, the net reclassification improvement of PNI (0.579, 95%CI 0.418–0.739) and CONUT (0.631, 95%CI 0.470–0.792) were higher in predicting short-term poor prognosis. The findings were further supported by subgroup analyses, and END had no significant mediated effects on the associations of malnutrition and 3-month unfavorable outcome.

Conclusion: Albumin-based malnutritional indices are reliable and feasible prognostic indicators in AIS patients, predicting short-term outcome independent of the type of reperfusion treatment. The applicability of these objective malnutritional indices may improve risk stratification and guide nutritional interventions at clinical setting in this vulnerable ischemic stroke population.(Like creating an EXACT PROTOCOL TO PREVENT THE PROBLEM! But you FAILED AT THAT! You're fired!)

1 Introduction

Acute ischemic stroke (AIS) is triggered by abrupt interruption of cerebral blood flow causing devastating brain damage and severe neurological deficits (1, 2), and it continues to rank as a primary cause of death and persistent disability globally (3). Rapid blood flow reperfusion therapy using intravenous thrombolysis (IVT) or/and endovascular thrombectomy (EVT) has greatly advanced the treatment of AIS. However, approximately 1 of 4 patients have poor outcome despite technically successful intervention (4). Therefore, strategies for the accurate prediction of neurological outcomes in at-risk individuals hold substantial clinical significance, potentially presenting an alternative framework for patient monitoring and improving post-reperfusion therapy outcomes.

The incidence of premorbid malnutrition risk was around 34% among AIS patients at admission (5, 6), and has been consistently associated with unfavorable outcome in both short- and long-term period (7–9). Beyond the cerebral deficits induced by the ischemic insult, inflammation and oxidative stress exert a pivotal role in the cascade of cerebral ischemic reperfusion injury (10). Particularly among patients undergoing IVT or EVT, the pre-existing nutritional status deteriorates rapidly after stroke onset due to stress associated with severe catabolism (11), and the interaction between post-stroke inflammatory injury and malnutrition is likely to be more pronounced (12, 13). Thus, early prognostic immuno-nutritional assessment is of critical importance among AIS patients, facilitating timely risk stratification and targeted nutritional intervention.

However, malnutrition in AIS patients is frequently overlooked by clinicians. The challenges in the assessment of nutritional status among AIS patients may account for this scenario. Aphasia, confusion and immobile symptoms of stroke patient may pose a considerable challenge to conventional nutritional assessments, such as body mass index (BMI) and nutritional assessment tool depending on the dietary history (14). Notably, the objective nutritional markers forecasting neurological outcomes during the early stage of stroke have attracted attention in recent years. The controlling nutritional status score (CONUT), the prognostic nutritional index score (PNI), and the neutrophil percentage-to-albumin ratio (NPAR) which can be easy to calculate using blood-based parameters and could be feasible to reflect balance of immune-nutritional status in clinical practice (15, 16). Previous studies on the prognostic significance of PNI and CONUT in AIS patients have primarily focused on individuals who did not undergo reperfusion therapy (17, 18), or patients treated with IVT or EVT alone (5, 7, 15, 19). As an emerging biomarker for assessing immune and systemic nutritional conditions, NPAR is increasingly being used in studies on disease risk and prognosis. Recently a few studies have indicated that NPAR is associated with stroke recurrence at 3-month follow-up (20), and early neurological improvement in AIS patients after IVT (21). Collectively, these findings suggested a potential association between albumin-based indicators integrating inflammation and nutritional status and the prognosis of AIS patients undergoing reperfusion therapy.

However, which composite indicator is more indicative of short-term adverse outcome risk in AIS patients undergoing reperfusion therapy (IVT/EVT alone or combined strategies) remains unclear and merits further exploration, particularly within the context of ischemic stroke treatment that prioritizes rapid reperfusion therapy. To address these gaps, we employed three objective nutritional indices to predict 3-month outcomes in AIS patients receiving reperfusion therapy and to ascertain which nutritional assessment tool is more suitable to early identify the risk in such stroke population.

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