Association between complete blood count-derived hematological inflammatory ratios and nutritional risk in elderly patients with acute ischemic stroke

 

'Associations' don't get you recovered, or are you too fucking stupid to see that? What prevents nutritional risk is the needed research, not this crapola! Like EXACT DIET PROTOCOLS, starting in the hospital!

• 49% malnutrition post-stroke (1 posts to April 2025)

You've known of the risk for over a year! 

SOLVE THE GODDAMN PROBLEM!

Association between complete blood count-derived hematological inflammatory ratios and nutritional risk in elderly patients with acute ischemic stroke

• 

  Liang’e Xu 1

• 

  Wenjing Wu 2

• 

  Chao Chen 3*

• 1. Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

• 2. Department of Neurology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China

Abstract

Background and aims: 

Mounting evidence suggests CBC-derived hematological inflammatory ratios correlate with nutritional status, yet few studies explore their cross-sectional associations with GNRI-defined concurrent nutritional risk in elderly patients with acute ischemic stroke (AIS). This single-center, cross-sectional, observational study was designed to evaluate the correlation between routine admission hematological markers and nutritional risk in elderly patients with AIS. Twelve CBC-derived indices were analyzed: lymphocyte ratio (LR), red blood cell-to-lymphocyte ratio (RLR), hemoglobin-to-lymphocyte ratio (HLR), monocyte-to-lymphocyte ratio (MLR), monocyte-to-neutrophil ratio (MNR), neutrophil-to-lymphocyte ratio (NLR), NLR-to-platelet ratio (NLR/PLT100), MLR-to-platelet ratio (MLR/PLT), platelet-to-neutrophil ratio (PNR), platelet-to-lymphocyte ratio (PLR), mean platelet volume-to-lymphocyte ratio (MPVLR), serum albumin-to-lymphocyte ratio (ALBLR).

Methods: 

Between January 2022 and January 2024, 540 elderly AIS patients (≥60 years) were enrolled. All participants underwent admission GNRI assessment and were split into GNRI-defined nutritional risk group (GNRI≤98, n = 245, 45.4%) and non-nutritional risk group (GNRI>98, n = 295). Venous blood was collected within 24 h on admission. Univariate and multivariate logistic regression were applied to explore cross-sectional correlations, and an exploratory combined statistical model was built. ROC curve, DeLong’s test, likelihood ratio test and AIC were used to evaluate model discrimination and fit.

Results: 

Multiple indicators including age, hypertension, ALT, UA, TG, LR, RLR, MLR, NLR, NLR/PLT100, MLR/PLT, PLR and MPVLR showed univariate correlations with nutritional risk. Multivariate regression identified MLR and NLR/PLT100 as independent correlates within this cohort; MLR showed the strongest association in this dataset instead of robust correlative ability. Adding MLR alone or combining MLR + NLR/PLT100 to base clinical variables significantly improved C-statistic. The combined model reached an AUC of 0.735, representing only moderate discriminative capacity, and it was merely the superior exploratory model limited to the present sample without external generalizability.

Conclusion: 

Within this single-center cohort, MLR exhibited the strongest cross-sectional correlation with GNRI-defined nutritional risk among all tested CBC-derived hematological inflammatory ratios. The composite model combining baseline clinical indicators, MLR and NLR/PLT*100 demonstrated moderate discriminative ability within the study sample, but is not yet robust enough to serve as an effective tool for routine clinical risk stratification.

Nutritional care in rehabilitation and acute care of stroke patients: a systematic review of clinical practice guidelines

This problem exists because no one in stroke has created diet protocols! We need protocols, NOT GUIDELINES! Solve the problem correctly, and that is NOT GUIDELINES!

 Nutritional care in rehabilitation and acute care of stroke patients: a systematic review of clinical practice guidelines

Karina Siewers*, Katrine Svaerke, Amira Eliza Rosenørn and Hanne Christensen

Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark

Edited by

Anthony Pak Hin Kong, The University of Hong Kong, Hong Kong SAR, China

Reviewed by

Meheroz H. Rabadi, United States Department of Veterans Affairs, United States

Ali Karahan, Uşak University, Türkiye

*Correspondence

Karina Siewers, karina.siewers.christensen@regionh.dk

Received 09 January 2025

Accepted 24 March 2025

Published 10 April 2025

Citation

Siewers K, Svaerke K, Rosenørn AE and Christensen H (2025) Nutritional care in rehabilitation and acute care of stroke patients: a systematic review of clinical practice guidelines. Front. Stroke 4:1558019. doi: 10.3389/fstro.2025.1558019

Background: Malnutrition and nutritional care are significant challenges for healthcare professionals treating stroke patients, in both acute care and during rehabilitation. This study aimed to assess and synthesize the nutritional care recommendations in clinical practice guidelines (CPGs) for managing malnutrition risk in stroke patients, evaluate the supporting evidence, identify research gaps, and assess the quality of the CPGs.

Methods: Three databases, along with National Medical Association websites and nutrition journals, were searched for CPGs published between 2019 and 2024 that provided recommendations on nutritional care for stroke patients. Two independent reviewers performed data extraction, and three reviewers independently assessed CPG quality and clinical applicability (using AGREE II and AGREE-REX tools).

Results: 13 CPGs were included in this review. These were of varying quality, with overall moderate AGREE II total scores [mean (SD), 55.2% (21.8%)]. Only two CPGs had an overall quality score above 70% based on AGREE-REX total scores, while five were categorized as poor quality (scores < 40%). Most guidelines strongly recommended early dysphagia screening upon hospital admission, including the provision of texture-modified foods for patients with dysphagia. However, recommendations on malnutrition, nutritional support, and supplementation were often either absent or inconsistent across guidelines and recommendations were mostly based on moderate to weak evidence.

Conclusion: This study highlights the critical need for more rigorous research, standardized approaches, and patient-centered studies to improve and optimize nutritional care practices for stroke patients.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024498430, PROSPERO registration ID: CRD42024498430.

Keywords

stroke, nutrition, systematic review, guidelines and recommendations, rehabilitation

Introduction

Malnutrition poses a significant challenge amongst patients with stroke, with up to 49% developing malnutrition post-stroke with further worsening during hospitalization and rehabilitation (Mosselman et al., 2013; Foley et al., 2009). Dysphagia increases the risk of malnutrition in post-stroke patients; however, malnutrition can occur in patients regardless of the presence of dysphagia (Foley et al., 2009). Managing malnutrition is complex and involves health care professionals from various professions.

Background

Healthcare providers require access to high-quality Clinical Practice Guidelines (CPGs). CPGs influence day-to-day clinical decisions and serve as a crucial tool in standardizing health care practices, bridging the gap between clinical practice and evidence-based scientific support.

Given the complexity of and diversity in nutritional interventions and assessment for stroke management, CPGs are needed to guide clinical decision-making, elevate patient care, and optimize outcomes. The study objectives were to assess the quality of eligible CPGs on nutritional care for stroke patients and to identify and synthesize key recommendations from the included CPGs.

Methods

The systematic review of CPGs was registered at PROSPERO (ID CRD42024498430) in advance and conducted in accordance with the PRISMA 2020 checklist for systematic reviews (see Supplementary material S1) (Page et al., 2021). Eligibility criteria were created in adherence to the PICAR statements [Population(s) and Clinical Area(s), Intervention(s), Comparator(s), Attributes of CPGs and Recommendation characteristics] framework (see Table 1) (Johnston et al., 2019).