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Özkan İ, Taylan S, Kurt Y. Relationship between altered taste and smell with malnutrition among hemodialysis patients. Hemodial Int 2024. [PMID: 38783569 DOI: 10.1111/hdi.13158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/02/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Alterations in taste and smell are among the most distressing symptoms experienced by haemodialysis patients. There is limited research on the relationship between these two symptoms and malnutrition in haemodialysis patients. This study aimed to investigate alterations in taste and smell in hemodialysis patients and their relationship with malnutrition. METHODS This cross-sectional study was carried out with 149 hemodialysis patients at the dialysis centers of three state hospitals. The Taste and Smell Dysfunction Questionnaire was used to assess the changes in patients' taste and smell, and the Prognostic Nutritional Index (PNI), as well as the Controlling Nutritional Status (CONUT) tool, were utilized to evaluate their nutritional status. FINDINGS A substantial percentage (45.6%) of patients reported an altered sense of smell, and 40.2% reported an altered sense of taste. The aspect of taste that was most abnormal was bitterness (46.7%); 53.0% of the patients were at moderate risk of malnutrition by PNI score, and 14.8% were categorized as malnourished by CONUT score. Malnutrition was related to dialysis vintage: a 1-year increase in vintage was associated with an increased risk of malnutrition (OR: 1.17, 95% CI 1.02-1.32, p < 0.001). Altered taste was associated with malnutrition: one-unit increase in the standard deviation of the taste subdimension score was associated with a relative risk of malnutrition (OR: 6.89, 95% CI 1.67-28.39, p < 0.001). A one-unit increase in the standard deviation of the smell subdimension was associated with relative risk of malnutrition (OR: 1.35, 95% CI 1.10-1.64, p < 0.001). DISCUSSION Malnutrition was found in a significantpercentage of hemodialysis patients. Altered taste and smell and the durationof dialysis treatment were significantly associated with malnutrition scores It isrecommended that healthcare professionals regularly assess alterations in tasteand smell in hemodialysis patients, as these alterations may be associated withmalnutrition, and manage these alterations accordingly.
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Affiliation(s)
- İlknur Özkan
- Internal Medicine Nursing Department, Kumluca Faculty of Health Sciences, Akdeniz University, Kumluca, Antalya, Turkey
| | - Seçil Taylan
- Surgical Nursing Department, Kumluca Faculty of Health Sciences, Akdeniz University, Kumluca, Antalya, Turkey
| | - Yücel Kurt
- Otolaryngology - Head and Neck Surgery, Finike State Hospital, Antalya, Turkey
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Zeng T, Chen Y, Huang H, Li S, Huang J, Xie H, Lin S, Chen S, Chen G, Yang D. Neuronal Intranuclear Inclusion Disease with NOTCH2NLC GGC Repeat Expansion: A Systematic Review and Challenges of Phenotypic Characterization. Aging Dis 2024:AD.2024.0131-1. [PMID: 38377026 DOI: 10.14336/ad.2024.0131-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/31/2024] [Indexed: 02/22/2024] Open
Abstract
Neuronal intranuclear inclusion disease (NIID) is a highly clinically heterogeneous neurodegenerative disorder primarily attributed to abnormal GGC repeat expansions in the NOTCH2NLC gene. This study aims to comprehensively explore its phenotypic characteristics and genotype-phenotype correlation. A literature search was conducted in PubMed, Embase, and the Cochrane Library from September 1, 2019, to December 31, 2022, encompassing reported NIID cases confirmed by pathogenic NOTCH2NLC mutations. Linear regressions and trend analyses were performed. Analyzing 635 cases from 85 included studies revealed that familial cases exhibited significantly larger GGC repeat expansions than sporadic cases (p < 0.001), and this frequency significantly increased with expanding GGC repeats (p trend < 0.001). Age at onset (AAO) showed a negative correlation with GGC repeat expansions (p < 0.001). The predominant initial symptoms included tremor (31.70%), cognitive impairment (14.12%), and muscle weakness (10.66%). The decreased or absent tendon reflex (DTR/ATR) emerged as a notable clinical indicator of NIID due to its high prevalence. U-fiber was observed in 79.11% of patients, particularly prominent in paroxysmal disease-dominant (87.50%) and dementia-dominant cases (81.08%). Peripheral neuropathy-dominant cases exhibited larger GGC repeat expansions (median = 123.00) and an earlier AAO (median = 33.00) than other phenotypes. Moreover, a significant genetic anticipation of 3.5 years was observed (p = 0.039). This study provides a comprehensive and up-to-date compilation of genotypic and phenotypic information on NIID since the identification of the causative gene NOTCH2NLC. We contribute a novel diagnostic framework for NIID to support clinical practice.
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Affiliation(s)
- Tian Zeng
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Yiqun Chen
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Honghao Huang
- Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengqi Li
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Jiaqi Huang
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Haobo Xie
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Shenyi Lin
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Siyao Chen
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Guangyong Chen
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dehao Yang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Doğan RB, Yavuz BG, Satilmis D, Afacan MA, Colak S. CRP/albumin, Glasgow prognostic score, and prognostic nutritional index as a predictor of mortality among delirium patients. Ir J Med Sci 2024; 193:469-476. [PMID: 37407872 DOI: 10.1007/s11845-023-03443-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND With the older populations growing each year, high mortality rates make delirium a valuable topic. AIM We aimed to analyze the parameters that could predict 30 days of mortality of the patients diagnosed in the emergency department (ED) with delirium. METHODS This retrospective study included 85 patients with a diagnosis of delirium. Glasgow prognostic score (GPS), prognostic nutritional index (PNI), and C-reactive protein (CRP)/albumin values of the patients and 30-day mortality rate were computed. The effectiveness of GPS, PNI, and CRP/albumin parameters in predicting 30-day mortality was analyzed. RESULTS The findings showed that the optimal cut-off value for albumin as determined by Youden's index in estimation of 30-day mortality was ≤ 36.8 [AUC: 0.830 (95% CI: 0.733-0.903; p < 0.001), with a sensitivity of 85.71% and specificity of 76.36%], while cut-off value for CRP/albumin was > 0.974 [AUC: 0.753 (95% CI: 0.647-0.840; p < 0.001); with a sensitivity of 85.71% and specificity of 70.51%], and cut-off value for PNI was ≤ 39.05 [AUC: 0.850 (95% CI: 0.756-0.918; p < 0.001) sensitivity 71.43% and specificity 92.31%]. Significant effectiveness of the values of GPS (odds ratio (OR) = 6.69; 95% confidence interval (CI): 1.69-26.37), PNI (OR = 0.83; 95% CI: 0.74-0.95), albumin (OR = 0.82; 95% CI: 0.71-0.94), and CAD (OR = 10.5; 95% CI: 1.85-59.45) was observed for predicting mortality in univariate regression analysis. CONCLUSIONS The findings obtained in this study suggest that GPS, PNI, and albumin parameters could be used to guide the clinician in predicting the 30-day mortality of patients diagnosed with delirium.
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Affiliation(s)
- Rümeysa Büşra Doğan
- Department of Neuroscience, Institute of Medical Science, Istanbul Medipol University, Istanbul, Turkey
- Department of Emergency Medicine, Çorlu State Hospital, Tekirdağ, Turkey
| | - Burcu Genc Yavuz
- Department of Emergency Medicine, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
| | - Dilay Satilmis
- Department of Emergency Medicine, University of Health Sciences, Sultan 2, Abdulhamit Han Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Ahmet Afacan
- Department of Emergency Medicine, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Sahin Colak
- Department of Emergency Medicine, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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Xiang W, Liang Y, Chen Z, Wang H, Guan Y, Xie D. Malnutrition and cerebral intraparenchymal damage in patients with thrombosis of dural sinuses and/or cerebral veins. BMC Neurol 2023; 23:449. [PMID: 38124042 PMCID: PMC10731804 DOI: 10.1186/s12883-023-03491-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUNDS Thrombosis of dural sinuses and/or cerebral veins (CVT) is an uncommon form of cerebrovascular disease. Malnutrition is common in patients with cerebrovascular disease, and early assessment of malnutrition and individualized nutritional treatment have been reported to improve functional outcomes of these patients. As for CVT patients, little is known about whether these patients would suffer from malnutrition. Also, the correlation between malnutrition and cerebral intraparenchymal damage (CID) in CVT patients was rarely studied. METHODS Patients with CVT were retrospectively included in this observational study. Multivariate logistic regressions were used to investigate the effects of nutritional indexes on the risk of CID. Subsequently, we used the independent risk factors to construct the nomogram model, and the consistency index (C-index), calibration curve and decision curve analysis (DCA) to assess the reliability and applicability of the model. RESULTS A total of 165 patients were included in the final analysis. Approximately 72.7% of CVT patients were regarded as malnourished by our malnutrition screening tools, and malnutrition is associated with an increased risk of CID. Prognostic Nutritional Index (PNI) (OR = 0.873; CI: 0.791, 0.963, p = 0.007) remained as an independent predictor for CID after adjustment for other risk factors. The nomogram model showed that PNI and gender have a great contribution to prediction. Besides, the nomogram model was consistent with the actual observations of CID risk (C-index = 0.65) and was of clinical significance. CONCLUSIONS We reported that malnutrition, as indicated by PNI, was associated with a higher incidence of CID in CVT patients. Also, we have constructed a nomogram for predicting the risk of CID in these patients.
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Affiliation(s)
- Weiwei Xiang
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No.160, Pujian Road, Shanghai, 200127, China
| | - Yangyang Liang
- The College of Renji, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Zhibo Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Hanmin Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Yangtai Guan
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No.160, Pujian Road, Shanghai, 200127, China.
| | - Dewei Xie
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
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Peng C, Gao L, Wu K, Jiang X, Chen X, Li C, Ge W, He L, Chen N. Association between the prognostic nutritional index and severe headache or migraine: a population-based study. Nutr Neurosci 2023; 26:1202-1211. [PMID: 36384436 DOI: 10.1080/1028415x.2022.2143958] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE Migraine is a highly prevalent headache disorder, and intake of various nutrients and special diets may improve migraine symptoms. We aimed to clarify the association between nutritional status and migraine. PATIENTS AND METHODS We collected the data of 1838/8953 (migraineurs/all participants) from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 cycle. We used weighted multivariable linear or logistic regression analyses to study the association between the prognostic nutritional index (PNI) and the occurrence of severe headache or migraine. RESULTS After adjusting for confounding variables, we found that mild (PNI 45-50) or moderate to severe (PNI <45) malnutrition were associated with higher prevalence of severe headache or migraine (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.00-1.12, P = 0.004; OR 1.07, 95% CI 1.03-1.12, P < 0.001). In addition, we found that those with severe headache or migraine consumed less alcohol, dietary fiber, cholesterol, total folate, vitamin A, riboflavin, vitamin B6, vitamin B12, vitamin C, vitamin K, selenium, potassium, magnesium, and copper, and consumed more caffeine and theobromine than did those without severe headache or migraine. CONCLUSION The PNI is associated with migraine prevalence, and may thus serve as a predictor of migraine risk and highlights the potential of nutrition-based strategies for migraine prevention and treatment.
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Affiliation(s)
- Cheng Peng
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Lijie Gao
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Kongyuan Wu
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Xin Jiang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Xiwen Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, People's Republic of China
- Department of Neurology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, People's Republic of China
| | - Changling Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Wenjing Ge
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Li He
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Ning Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, People's Republic of China
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Yu X, Ge P, Zhai Y, Liu W, Zhang Q, Ye X, Liu X, Wang R, Zhang Y, Zhao J, Zhang D. The prognostic nutrition index is a predictor for long-term outcomes after revascularization in adult moyamoya disease. Acta Neurochir (Wien) 2023; 165:3623-3630. [PMID: 37777693 DOI: 10.1007/s00701-023-05816-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/10/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND AND PURPOSE The prognostic nutrition index (PNI) has been associated with the prognosis of various medical disorders. This study aimed to explore the correlation between PNI and the long-term outcomes of adult patients afflicted with moyamoya disease (MMD). METHODS This prospective study initially employed 138 adult patients diagnosed with MMD. After excluding 15 patients who did not meet the criteria, a total of 123 patients were included. Participants were divided into three groups based on the tertile of change in the PNI score. Statistical analysis compared clinical information and lab tests among the groups. The study was conducted between July 1 and December 31, 2019. RESULTS After adjusting for multiple variables, patients in the upper two tertiles (tertiles 2-3) exhibited a significantly lower risk of adverse long-term outcomes compared to those in the lowest tertile (tertile 1) (OR, 0.089; 95% CI, 0.009-0.895; P = 0.040). Furthermore, adding PNI tertile to traditional risk factors substantially improved predicting adverse long-term outcomes (net reclassification improvement: 98.03%, P = 0.000; integrated discrimination improvement: 4.65%, P = 0.030). However, there was no statistically significant difference between the first PNI tertile (tertile 1) and the upper two tertiles (tertiles 2-3) in the Kaplan-Meier curve of stroke incidence (log-rank test, P = 0.244). CONCLUSIONS A higher PNI level was significantly associated with a reduced risk of unfavorable long-term outcomes. Nevertheless, the PNI score did not predict stroke recurrence during extended follow-up. This study provides insights into a potential predictor of adverse long-term outcomes after revascularization in MMD patients. REGISTRATION NUMBER ChiCTR2000031412.
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Affiliation(s)
- Xiaofan Yu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, Beijing, China
| | - Peicong Ge
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
- Center of Stroke Beijing Institute for Brain Disorders, Beijing, China.
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
- Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, Beijing, China.
| | - Yuanren Zhai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, Beijing, China
| | - Wei Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, Beijing, China
| | - Qian Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, Beijing, China
| | - Xun Ye
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, Beijing, China
| | - Xingju Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, Beijing, China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, Beijing, China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, Beijing, China
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
- Center of Stroke Beijing Institute for Brain Disorders, Beijing, China.
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
- Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, Beijing, China.
- Department of Neurosurgery, Beijing Hospital, Beijing, China.
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Zheng Y, Huang Y, Li H. Hemoglobin albumin lymphocyte and platelet score and all-cause mortality in coronary heart disease: a retrospective cohort study of NHANES database. Front Cardiovasc Med 2023; 10:1241217. [PMID: 38028472 PMCID: PMC10679332 DOI: 10.3389/fcvm.2023.1241217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Aim Anemia, inflammatory status, and malnutrition are all important factors in the prognosis of cardiovascular disease (CVD), and their interactions are also noteworthy. A recent scoring system, the hemoglobin albumin lymphocyte and platelet (HALP) score, combining multi-dimensional metrics, has been used in the prognoses of many diseases except coronary heart disease (CHD). Herein, this study aims to explore the association between HALP score and all-cause mortality in patients with CHD. Methods Demographic and clinical data of adult patients with CHD were extracted from the National Health and Nutrition Examination Surveys (NHANES) database from 2003 to 2018 in this retrospective cohort study. Weighted univariate and multivariate COX proportional hazard models were used for covariates screening and exploration of the association between HALP score and all-cause mortality. The evaluation indexes were hazard ratios (ORs) and 95% confidence intervals (CIs). Kaplan-Meier (KM) curve and the receiver operator characteristic (ROC) curve were used to assess the predictive performance of HALP on CHD prognosis. In addition, subgroup analyses of age and congestive heart failure (CHF) were also performed. Results Among the eligible patients, 657 died of all-cause mortality. After adjusting for the covariates including age, education level, PIR, marital status, smoking, physical activity, total energy intake, CHF, stroke, hypertension, DM, CKD, cancer or malignancy, monocyte, drug for CVD, treatment for anemia, anticoagulants drug, and adrenal cortical steroids, we found that HALP score was negatively associated with the risk of all-cause mortality [HR = 0.83, 95% CI: (0.74-0.93)]. Compared with patients with high HALP scores, those who had lower HALP scores seemed to have a higher risk of all-cause mortality (all P < 0.05). HALP score has a potential predictive value on CHD prognosis with an area under the curve (AUC) of 0.61. Furthermore, in patients aged <65 years, with or without CHF, a lower HALP score was also associated with a higher risk of all-cause mortality (all P < 0.05). Conclusions HALP score has a potential predictive value on CHD prognosis; however, the causal association between HALP score and mortality in patients with CHD needs further exploration.
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Affiliation(s)
| | | | - Haitao Li
- Department of Cardiology, Hainan Province Clinical Medical Center, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
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Nergiz S, Aydin Ozturk P. The Prognostic Nutritional Index and Mortality in Patients With Ventriculoperitoneal Shunt Infection. Clin Pediatr (Phila) 2023:99228231209725. [PMID: 37937580 DOI: 10.1177/00099228231209725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
The objective of this study was to investigate the relationship between mortality and the prognostic nutritional index (PNI) in the pediatric patient group with ventriculoperitoneal shunt (VPS) infection. A total of 63 pediatric patients with a VPS infection and positive cerebrospinal fluid (CSF) culture were retrospectively registered. The CSF specimens were analyzed to conduct culture and microscopic evaluation. A total of 44.4% of the cases were men and 55.6% of the cases were women. Patients were divided into 2 groups (survivor and non-survivor patients). When survivor and non-survivor patients were compared, it was found that CSF leukocytes, CSF glucose, CSF protein, CSF/blood glucose ratio, lymphocyte, albumin, and PNI levels were lower in the non-survivor patients' group. Nevertheless, blood glucose and CRP (C-reactive protein) were significantly higher in the non-survivor patients' group than in the survivor patients' group. In our investigation, we suggested that low PNI was related to high mortality in cases of VPS infection.
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Affiliation(s)
- Sebnem Nergiz
- Department of Nutrition and Dietetics, Ataturk Faculty of Health Sciences, Dicle University, Diyarbakir, Turkey
| | - Pinar Aydin Ozturk
- Department of Nutrition and Dietetics, Ataturk Faculty of Health Sciences, Dicle University, Diyarbakir, Turkey
- Department of Neurosurgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Health Sciences University of Turkey, Diyarbakir, Turkey
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Wang M, Dai Z, Zhang X, Xu X, Sun Y, Gong F, Qin B, Wang J, Liu B, Tang H, Li T, Zhang J, Wang J, Chen W, Ma L, Han Z, Liu D. The metabolic score for insulin resistance as a predictor of clinical outcome in stroke patients treated by intravenous thrombolysis. Neurol Sci 2023; 44:3587-3594. [PMID: 37202593 DOI: 10.1007/s10072-023-06848-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 05/08/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND PURPOSE Insulin resistance is associated with clinical outcomes among patients with ischemic stroke. We aimed to investigate the association between metabolic score for insulin resistance (METS-IR) and clinical outcomes in stroke patients treated by intravenous thrombolysis (IVT). METHODS We recruited participants treated with IVT from a prospective registry including 3 stroke centers. Poor outcome was defined as a modified Rankin scale score ≥ 3 points at 90 days after the index stroke. We performed logistic regression models to investigate the association between METS-IR and the risk of poor outcome. We used the receiver operative characteristic to assess the discriminative ability and the restricted cubic spline to explore the relationship between METS-IR and the poor outcome. RESULTS This study enrolled a total of 1074 patients (median age, 68; 63.8% male). Three hundred sixty (33.5%) patients had poor outcome after IVT. METS-IR was associated with the risk of the poor outcome with the increase of confounding factors in models (odds ratio [OR], 1.078; 95% confidence interval [CI], 1.058-1.099; P < 0.001). The area under the curve for METS-IR for predicting the poor outcome was 0.790 (95% CI, 0.761-0.819). The restricted cubic spline revealed an increasing and non-linear association between METS-IR and the poor outcome (P for non-linearity < 0.001). CONCLUSION Our study found that METS-IR was associated with an increased risk of poor outcome after IVT. Further studies are warranted to investigate the efficacy of anti-diabetic agents regarding IR on clinical outcomes after IVT.
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Affiliation(s)
- Mingzhe Wang
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 528 Zhang-Heng Road, Pu-Dong New Area, Shanghai, 201203, China
| | - Zheng Dai
- Department of Neurology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, Jiangsu Province, 214023, China
| | - Xiaohao Zhang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210000, Jiangsu, China
| | - Xiaochen Xu
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 528 Zhang-Heng Road, Pu-Dong New Area, Shanghai, 201203, China
| | - Yan Sun
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 528 Zhang-Heng Road, Pu-Dong New Area, Shanghai, 201203, China
| | - Fan Gong
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 528 Zhang-Heng Road, Pu-Dong New Area, Shanghai, 201203, China
| | - Baofeng Qin
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 528 Zhang-Heng Road, Pu-Dong New Area, Shanghai, 201203, China
| | - Jun Wang
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 528 Zhang-Heng Road, Pu-Dong New Area, Shanghai, 201203, China
| | - Bin Liu
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 528 Zhang-Heng Road, Pu-Dong New Area, Shanghai, 201203, China
| | - Haiyan Tang
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 528 Zhang-Heng Road, Pu-Dong New Area, Shanghai, 201203, China
| | - Tingting Li
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 528 Zhang-Heng Road, Pu-Dong New Area, Shanghai, 201203, China
| | - Jinsi Zhang
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 528 Zhang-Heng Road, Pu-Dong New Area, Shanghai, 201203, China
| | - Jiecheng Wang
- Department of Encephalopathy, Qinghai Provincial Hospital of Traditional Chinese Medicine, Xining, 810000, Qinghai Province, China
| | - Wenjie Chen
- Department of Neurology, Nanping People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Nanping, 353000, Fujian Province, China
| | - Ling Ma
- Department of Encephalopathy, Qinghai Provincial Hospital of Traditional Chinese Medicine, Xining, 810000, Qinghai Province, China
| | - Zhenxiang Han
- Department of Neurology and Rehabilitation, Seventh People's Hospital of Shanghai University of TCM, 200137, No 358 Datong Road, Shanghai, 200137, China.
| | - Dezhi Liu
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 528 Zhang-Heng Road, Pu-Dong New Area, Shanghai, 201203, China.
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10
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Wang X, Kang Z, Wang Y, Zheng Y, Wei Y. Application of Prognostic Nutritional Index in the Predicting of Prognosis in Young Adults with Acute Ischemic Stroke. World Neurosurg 2023; 178:e292-e299. [PMID: 37467954 DOI: 10.1016/j.wneu.2023.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND The incidence of ischemic stroke in young adults (18-45 years old) is increasing gradually. However, performing nutritional assessment in stroke patients is often challenging due to the lack of an accepted standard for nutritional assessment. METHODS Two hundred sixty young stroke patients were recruited in this study and 144 cases in the good prognosis group and 116 cases in the poor prognosis group were scored according to the modified Rankin scale 90 days after treatment. The National Institutes of Health Stroke Scale was performed on admission and discharge of patients. Serum interleukin 6 and high-sensitivity C-reactive protein were detected at patient presentation. The Prognostic Nutritional Index (PNI) was assessed on admission. Calculation formula of PNI score: serum albumin (g/L) + 5× total lymphocyte count (109/L). RESULTS The PNI at admission of young stroke patients with poor prognosis was higher than that of those with good prognosis. PNI at admission was significantly negatively correlated with National Institutes of Health Stroke Scale at discharge and modified Rankin scale score after 90 days in young stroke patients. PNI at admission was also significantly negatively correlated with serum levels of high-sensitivity C-reactive protein and interleukin -6 at admission. CONCLUSIONS PNI has a statistically predictive value for the 90-day prognosis of young stroke patients.
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Affiliation(s)
- Xinying Wang
- Department of Neurology, Hengshui People's Hospital, Hengshui, Hebei, China.
| | - Zhilei Kang
- Medical Imaging Center, Hengshui People's Hospital, Hengshui, Hebei, China
| | - Yongchao Wang
- Department of Neurology, Hengshui People's Hospital, Hengshui, Hebei, China
| | - Yuelin Zheng
- Medical Department, Hengshui People's Hospital, Hengshui, Hebei, China
| | - Yan Wei
- Department of Neurology, Hengshui People's Hospital, Hengshui, Hebei, China
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11
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Kim JH, Kwon YS, Lee JJ, Lee SH, Sohn JH. Association between Malnutrition and Migraine Risk Assessed Using Objective Nutritional Indices. Nutrients 2023; 15:3828. [PMID: 37686859 PMCID: PMC10490427 DOI: 10.3390/nu15173828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
Dietary triggers are frequently linked to migraines. Although some evidence suggests that dietary interventions might offer a new avenue for migraine treatment, the connection between migraine and nutrition remains unclear. In this study, we explored the association between nutritional status and migraines. Clinical data spanning 11 years were sourced from the Smart Clinical Data Warehouse. The nutritional statuses of 6603 migraine patients and 90,509 controls were evaluated using the Controlling Nutrition Status (CONUT) score and the Prognostic Nutrition Index (PNI). The results showed that individuals with mild, moderate, and severe malnutrition were at a substantially higher risk of migraines than those with optimal nutrition, as determined by the CONUT score (adjusted odds ratio [aOR]: 1.72, 95% confidence interval [CI]: 1.63-1.82; aOR: 5.09, 95% CI: 4.44-5.84; aOR: 3.24, 95% CI: 2.29-4.59, p < 0.001). Similarly, moderate (PNI: 35-38) and severe (PNI < 35) malnutrition were associated with heightened migraine prevalence (aOR: 4.80, 95% CI: 3.85-5.99; aOR: 3.92, 95% CI: 3.14-4.89, p < 0.001) compared to those with a healthy nutritional status. These findings indicate that both the CONUT and PNI may be used as predictors of migraine risk and underscore the potential of nutrition-oriented approaches in migraine treatment.
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Affiliation(s)
- Jong-Ho Kim
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si 24253, Republic of Korea; (J.-H.K.); (Y.-S.K.); (J.J.L.)
- Institute of New Frontier Research Team, College of Medicine, Hallym University, Chuncheon-si 24252, Republic of Korea;
| | - Young-Suk Kwon
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si 24253, Republic of Korea; (J.-H.K.); (Y.-S.K.); (J.J.L.)
- Institute of New Frontier Research Team, College of Medicine, Hallym University, Chuncheon-si 24252, Republic of Korea;
| | - Jae Jun Lee
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si 24253, Republic of Korea; (J.-H.K.); (Y.-S.K.); (J.J.L.)
- Institute of New Frontier Research Team, College of Medicine, Hallym University, Chuncheon-si 24252, Republic of Korea;
| | - Sang-Hwa Lee
- Institute of New Frontier Research Team, College of Medicine, Hallym University, Chuncheon-si 24252, Republic of Korea;
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si 24253, Republic of Korea
| | - Jong-Hee Sohn
- Institute of New Frontier Research Team, College of Medicine, Hallym University, Chuncheon-si 24252, Republic of Korea;
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si 24253, Republic of Korea
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12
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Di Vincenzo O, D'Elia L, Ballarin G, Pasanisi F, Scalfi L. Controlling Nutritional Status (CONUT) score and the risk of mortality or impaired physical function in stroke patients: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2023; 33:1501-1510. [PMID: 37336716 DOI: 10.1016/j.numecd.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/07/2023] [Accepted: 05/09/2023] [Indexed: 06/21/2023]
Abstract
AIMS The Controlling Nutritional Status (CONUT) score is a tool for assessing the risk of malnutrition (undernutrition) that can be calculated from albumin concentration, total peripheral lymphocyte count, and total cholesterol concentration. CONUT score has been proposed as a promising prognostic marker in several clinical settings; however, a consensus on its prognostic value in patients with stroke is lacking. The aim of this systematic review and meta-analysis was to evaluate the relationship between CONUT score and clinical outcomes in patients with stroke based on all current available studies. DATA SYNTHESIS Systematic research on PubMed, Scopus and Web of Science from inception to February 2023 was performed on the association between CONUT score and clinical outcomes in patients with stroke. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Methodological quality was evaluated using the Newcastle-Ottawa Scale quality assessment tool. Pooled effect estimation was calculated by a random-effect model. Through the initial literature search, 15 studies (all high-quality) including 16 929 patients were found to be eligible and analysed in the meta-analysis. A significant risk of malnutrition (in most studies defined by a CONUT score ≥5) was directly associated with mortality, higher risk of poor functional outcome according to the modified Rankin Scale and total infection development. Evidence was consistent for acute ischaemic stroke and preliminary for acute haemorrhagic stroke. CONCLUSION CONUT score is an independent prognostic indicator, and it is associated with major disability and infection development during hospitalisation. PROSPERO ID CRD42022306560.
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Affiliation(s)
- Olivia Di Vincenzo
- Department of Public Health, School of Medicine, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Lanfranco D'Elia
- Department of Clinical Medicine and Surgery School of Medicine, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Giada Ballarin
- Department of Movement Sciences and Wellbeing, "Parthenope" University, Via Ammiraglio Ferdinando Acton 38, 80133, Naples, Italy
| | - Fabrizio Pasanisi
- Department of Clinical Medicine and Surgery School of Medicine, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Luca Scalfi
- Department of Public Health, School of Medicine, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
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13
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Liu P, Tian H, Ji T, Zhong T, Gao L, Chen L. Predictive Value of Malnutrition, Identified via Different Nutritional Screening or Assessment Tools, for Functional Outcomes in Patients with Stroke: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:3280. [PMID: 37513698 PMCID: PMC10383200 DOI: 10.3390/nu15143280] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Malnutrition affects more than half of patients with stroke. Although malnutrition leads to more deaths, a longer hospital stay, and higher costs, there is still a lack of consensus regarding the impact of malnutrition on physical functional outcomes in patients with stroke, and there are large differences in the diagnostic effects of nutritional screening or assessment tools for malnutrition. This study aimed to explore the impact of malnutrition in patients with stroke and assess the significance of current nutritional screening and assessment tools for these patients. METHODS Six databases were systematically searched until October 2022. Cohort studies meeting the eligibility criteria were included. Pooled effects were calculated using random-effects models. RESULTS Twenty-six studies with 21,115 participants were included. The pooled effects of malnutrition on poor functional outcome, FIM points, and dysphagia were OR = 2.72 (95% CI = 1.84-4.06), WMD = -19.42(95% CI = -32.87--5.96), and OR = 2.80 (95% CI = 1.67-4.67), respectively. CONCLUSION Malnutrition adversely affects the recovery of physical and swallowing functions in patients with stroke. Nutritional assessments consistently predict the outcomes of physical function in patients with stroke.
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Affiliation(s)
- Peiqi Liu
- School of Nursing, Jilin University, Changchun 130021, China
| | - Huimin Tian
- School of Nursing, Jilin University, Changchun 130021, China
| | - Tianliang Ji
- The First Hospital of Jilin University, Changchun 130021, China
| | - Tangsheng Zhong
- School of Nursing, Jilin University, Changchun 130021, China
- The First Hospital of Jilin University, Changchun 130021, China
| | - Lan Gao
- The First Hospital of Jilin University, Changchun 130021, China
| | - Li Chen
- School of Nursing, Jilin University, Changchun 130021, China
- Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun 130021, China
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14
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Zhu B, Ou Y, Guo X, Liu W, Wu L. A low prognostic nutritional index is associated with chronic subdural hematoma recurrence. Neurosurg Rev 2023; 46:139. [PMID: 37296275 DOI: 10.1007/s10143-023-02042-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/28/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
Chronic subdural hematoma (CSDH) is a common neurosurgical condition. Inflammation has been found to play an essential role in the formation of CSDHs, and the prognostic nutritional index (PNI), a nutritional and inflammatory baseline marker, plays a role in predicting the prognosis of many diseases. We aimed to identify the relationship between PNI and CSDH recurrence. This study retrospectively analyzed 261 CSDH patients who underwent burr hole evacuation in Beijing Tiantan Hospital from August 2013 to March 2018. The PNI was calculated as 5 ∗ lymphocyte count (109/L) + serum albumin concentration (g/L), and these markers were obtained from the peripheral blood test on the day of discharge from the hospital. Recurrence was defined as operated hematoma enlargement accompanied by newly emerging neurological disorders. The comparison of baseline characteristics demonstrated that patients with bilateral hematoma and low levels of albumin, lymphocytes, and PNI were more likely to be recurrent. After adjusting for age, sex, and other important variables, decreased PNI levels were associated with an increased risk of CSDH (OR, 0.803, 95% CI: 0.715-0.902, p = 0.001). The addition of PNI to conventional risk factors significantly improved the risk prediction of CSDH (net reclassification index: 71.12%, p = 0.001; integrated discrimination index: 10.94%, p = 0.006). A low PNI level is associated with an increased risk of CSDH recurrence. As an easily obtainable nutritional and inflammatory marker, PNI may play a significant role in predicting the recurrence of CSDH patients.
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Affiliation(s)
- Bingcheng Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yunwei Ou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xufei Guo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Weiming Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
- Neurological Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China.
| | - Liang Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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15
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Fan MC, Li HT, Sun J, Guan D, Yang ZJ, Feng YG. Preoperative prognostic nutrition index can independently predict the 6-month prognosis of elderly patients undergoing neurosurgical clipping for aneurysmal subarachnoid hemorrhage. Neurosurg Rev 2023; 46:117. [PMID: 37165260 DOI: 10.1007/s10143-023-02021-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/16/2023] [Accepted: 05/01/2023] [Indexed: 05/12/2023]
Abstract
The number of elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) is increasing annually. The prognostic nutritional index (PNI) is used as a novel and valuable prognostic marker for various neoplastic diseases and other critical illnesses. This study aimed to identify the short-term prognostic value of preoperative PNI in elderly patients who underwent neurosurgical clipping for aSAH. This retrospective study included elderly patients with aSAH who underwent neurosurgical clipping from January 2018 to December 2020. Clinical variables and 6-month outcomes were collected and compared. Epidemiological data and effect factors of prognosis were evaluated. Multivariate logistic regression and receiver operating characteristics (ROC) curve analyses were used to evaluate the predictive value of preoperative PNI. Multiple logistic regression was performed to establish a nomogram. A total of 124 elderly patients were enrolled. Multivariate logistic regression analysis showed that preoperative PNI (odds ratio (OR), 0.779; 95% confidence interval (CI), 0.689-0.881; P < 0.001), Hunt-Hess grade (OR, 3.291; 95%CI, 1.816-5.966; P < 0.001), and hydrocephalus (OR, 9.423; 95%CI, 2.696-32.935; P < 0.001) were significant predictors. The area under the ROC curve of PNI was 0.829 (95% CI, 0.755-0.903; P < 0.001) with a sensitivity and specificity of 68.4% and 83.3%, respectively, and the cutoff value was 46.36. Patients with preoperative PNI of < 46.36 had a significantly unfavorable 6-months prognosis (F = 40.768, P < 0.001). Preoperative PNI is independently correlated with the 6-month prognosis in elderly patients who undergo neurosurgical clipping for aSAH.
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Affiliation(s)
- Ming-Chao Fan
- Department of Neurosurgery, the Affiliated Hospital of Qingdao University, Qingdao, China
- Department of Neurosurgical Intensive Care Unit, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Huan-Ting Li
- Department of Neurosurgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jian Sun
- Department of Neurosurgical Intensive Care Unit, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dong Guan
- Department of Neurosurgery, Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser Hospital), Qingdao, China
| | - Zheng-Jie Yang
- Department of Neurology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yu-Gong Feng
- Department of Neurosurgery, the Affiliated Hospital of Qingdao University, Qingdao, China.
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16
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Kim Y, Lee M, Mo HJ, Kim C, Sohn JH, Yu KH, Lee SH. The association between malnutrition status and hemorrhagic transformation in patients with acute ischemic stroke receiving intravenous thrombolysis. BMC Neurol 2023; 23:106. [PMID: 36918775 PMCID: PMC10012700 DOI: 10.1186/s12883-023-03152-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/08/2023] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVES We evaluated the impact of malnutrition as estimated by the controlling nutritional status (CONUT) score and prognostic nutritional index (PNI) on hemorrhagic transformation (HT) and stroke outcomes after intravenous thrombolysis (IVT). MATERIALS AND METHODS Using a multicenter registry database, we enrolled 808 patients with acute ischemic stroke who received IVT between August 2013 and May 2021. We defined malnutrition as a CONUT score ≥ 2 and low PNI. The primary outcome measure was the occurrence of symptomatic HT contributing to early neurologic deterioration (END-SHT) after IVT. Multivariable analysis was performed to analyze the association between CONUT score, PNI, and END-SHT after IVT. RESULTS The rate of END-SHT was higher with increasing CONUT scores and PNI values. In the multivariable analysis, CONUT score ≥ 5 and low PNI were significantly associated with END-SHT (odds ratio [95% confidence interval], CONUT score ≥ 5: 12.23 [2.41-62.07], p = 0.003; low PNI: 4.98 [1.76-14.09], p = 0.003). The receiver operating characteristic curve showed that both the CONUT score and PNI had good predictive ability. The cutoff values for CONUT and PNI were 5 and 42.3, respectively, for END-SHT. CONCLUSION Malnutrition, as denoted by a higher CONUT score and lower PNI, was associated with END-SHT. The joint application of both nutritional markers could be useful in predicting END-SHT after IVT.
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Affiliation(s)
- Yerim Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Minwoo Lee
- Department of Neurology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Hee Jung Mo
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Chulho Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, South Korea.,Institute of New Frontier Research Team, Hallym University, Chuncheon, South Korea
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, South Korea.,Institute of New Frontier Research Team, Hallym University, Chuncheon, South Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Sang-Hwa Lee
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, South Korea. .,Institute of New Frontier Research Team, Hallym University, Chuncheon, South Korea.
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17
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The Assessment of the Risk of Malnutrition (Undernutrition) in Stroke Patients. Nutrients 2023; 15:nu15030683. [PMID: 36771390 PMCID: PMC9921740 DOI: 10.3390/nu15030683] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Malnutrition is common in stroke patients, as it is associated with neurological and cognitive impairment as well as clinical outcomes. Nutritional screening is a process with which to categorize the risk of malnutrition (i.e., nutritional risk) based on validated tools/procedures, which need to be rapid, simple, cost-effective, and reliable in the clinical setting. This review focuses on the tools/procedures used in stroke patients to assess nutritional risk, with a particular focus on their relationships with patients' clinical characteristics and outcomes. Different screening tools/procedures have been used in stroke patients, which have shown varying prevalence in terms of nutritional risk (higher in rehabilitation units) and significant relationships with clinical outcomes in the short- and long term, such as infection, disability, and mortality. Indeed, there have been few attempts to compare the usefulness and reliability of the different tools/procedures. More evidence is needed to identify appropriate approaches to assessing nutritional risk among stroke patients in the acute and sub-acute phase of disease or during rehabilitation; to evaluate the impact of nutritional treatment on the risk of malnutrition during hospital stay or rehabilitation unit; and to include nutritional screening in well-defined nutritional care protocols.
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18
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Sun Y, Ji Y, Wu K, Wang H, Guo Y, Xu X, Shang X, Yang Q, Huang X, Zhou Z. [Association of nutritional status with clinical outcomes of stroke patients with acute anterior circulation large vessel occlusion after emergency endovascular treatment]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2022; 42:1397-1402. [PMID: 36210714 DOI: 10.12122/j.issn.1673-4254.2022.09.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To explore the influence of nutritional status on 90-day functional outcomes of stroke patients with acute large vessel occlusion in the anterior circulation after endovascular treatment (EVT). METHODS We retrospectively analyzed the baseline, laboratory, surgical and 90-day follow-up data of patients with stroke resulting from acute large vessel occlusion in the anterior circulation, who underwent emergency endovascular treatment in our hospital from July, 2015 to December, 2020. A favorable outcome was defined as a modified Rankin scale score ≤2 at 90 days. Univariate and multivariate regression analyses were performed to explore the relationship between nutritional status and 90-day functional outcomes of the patients. RESULTS A total of 459 patients (mean age of 68.29±11.21 years, including 260 males) were enrolled in this study. According to their prognostic nutritional index (PNI), the patients were divided into normal nutrition group (392 cases, 85.4%), moderate malnutrition group (44 cases, 9.6%), and severe malnutrition group (23 cases, 5.0%). Univariate analysis showed that the patients with good clinical outcomes had a lower proportion of malnutrition with a younger age, a lower rate of diabetes, lower baseline blood pressure, lower baseline NIHSS score, higher baseline ASPECT score, and higher rates of good collateral circulation and complete vascular recanalization. Multivariate analysis showed that in addition to age, diabetes, baseline systolic blood pressure, successful recanalization, baseline ASPECT score, baseline NIHSS score and collateral circulation, a greater PNI was a protective factor for a good 90-day outcome of patients after EVT (moderate vs severe: OR=0.245, 95% CI: 0.066-0.908, P=0.035; normal vs severe: OR=0.185, 95% CI: 0.059-0.581, P=0.004). CONCLUSION Nutritional status an important factor affecting the 90-day outcomes after EVT of stroke patients with acute large vessel occlusion in the anterior circulation.
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Affiliation(s)
- Y Sun
- Department of Neurology, Yijishan Hosotial, The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, China
| | - Y Ji
- Department of Neurology, Yijishan Hosotial, The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, China
| | - K Wu
- Department of Neurology, Yijishan Hosotial, The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, China
| | - H Wang
- Department of Neurology, Yijishan Hosotial, The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, China
| | - Y Guo
- Department of Neurology, Yijishan Hosotial, The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, China
| | - X Xu
- Department of Neurology, Yijishan Hosotial, The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, China
| | - X Shang
- Department of Neurology, Yijishan Hosotial, The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, China
| | - Q Yang
- Department of Neurology, Yijishan Hosotial, The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, China
| | - X Huang
- Department of Neurology, Yijishan Hosotial, The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, China
| | - Z Zhou
- Department of Neurology, Yijishan Hosotial, The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, China
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19
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A prospective epidemiological analysis of controlling nutritional status score with the poor functional outcomes in Chinese patients with haemorrhagic stroke. Br J Nutr 2022; 128:192-199. [PMID: 34409929 DOI: 10.1017/s0007114521003184] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Nutritional Risk Screening index is a standard tool to assess nutritional risk, but epidemiological data are scarce on controlling nutritional status (CONUT) as a prognostic marker in acute haemorrhagic stroke (AHS). We aimed to explore whether the CONUT may predict a 3-month functional outcome in AHS. In total, 349 Chinese patients with incident AHS were consecutively recruited, and their malnutrition risks were determined using a high CONUT score of ≥ 2. The cohort patients were divided into high-CONUT (≥ 2) and low-CONUT (< 2) groups, and primary outcomes were a poor functional prognosis defined as the modified Rankin Scale (mRS) score of ≥ 3 at post-discharge for 3 months. Odds ratios (OR) with 95 % confidence intervals (CI) for the poor functional prognosis at post-discharge were estimated by using a logistic analysis with additional adjustments for unbalanced variables between the high-CONUT and low-CONUT groups. A total of 328 patients (60·38 ± 12·83 years; 66·77 % male) completed the mRS assessment at post-discharge for 3 months, with 172 patients at malnutrition risk at admission and 104 patients with a poor prognosis. The levels of total cholesterol and total lymphocyte counts were significantly lower in high-CONUT patients than low-CONUT patients (P = 0·012 and < 0·001, respectively). At 3-month post discharge, there was a greater risk for the poor outcome in the high-CONUT compared with the low-CONUT patients at admission (OR: 2·32, 95 % CI: 1·28, 4·17). High-CONUT scores independently predict a 3-month poor prognosis in AHS, which helps to identify those who need additional nutritional managements.
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Ji Y, Xu X, Wu K, Sun Y, Wang H, Guo Y, Yang K, Xu J, Yang Q, Huang X, Zhou Z. Prognosis of Ischemic Stroke Patients Undergoing Endovascular Thrombectomy is Influenced by Systemic Inflammatory Index Through Malignant Brain Edema. Clin Interv Aging 2022; 17:1001-1012. [PMID: 35814350 PMCID: PMC9259057 DOI: 10.2147/cia.s365553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients and Methods Results Conclusion
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Affiliation(s)
- Yachen Ji
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
| | - Xiangjun Xu
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
| | - Kangfei Wu
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
| | - Yi Sun
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
| | - Hao Wang
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
| | - Yapeng Guo
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
| | - Ke Yang
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
| | - Junfeng Xu
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
| | - Qian Yang
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
| | - Xianjun Huang
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
| | - Zhiming Zhou
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of China
- Correspondence: Xianjun Huang; Zhiming Zhou, Department of Neurology, The First Affiliated Hospital of Wannan Medical College, 2# East Zheshan Road, Wuhu, 241000, People’s Republic of China, Tel +86-25-80860124, Fax +86-25-84664563, Email ;
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Immune biomarkers are associated with poststroke fatigue at six months in patients with ischemic stroke. J Clin Neurosci 2022; 101:228-233. [DOI: 10.1016/j.jocn.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/04/2022] [Accepted: 05/23/2022] [Indexed: 11/18/2022]
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Shiga Y, Nezu T, Shimomura R, Sato K, Himeno T, Terasawa Y, Aoki S, Hosomi N, Kohriyama T, Maruyama H. Various effects of nutritional status on clinical outcomes after intracerebral hemorrhage. Intern Emerg Med 2022; 17:1043-1052. [PMID: 34853991 DOI: 10.1007/s11739-021-02901-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/19/2021] [Indexed: 11/30/2022]
Abstract
Although the assessment of nutrition is essential for stroke patients, detailed associations between nutritional status at admission, subsequent complications, and clinical outcomes in patients with acute intracerebral hemorrhage (ICH) are unclear. We aimed to elucidate these associations using the Controlling Nutritional Status (CONUT) score. Consecutive patients with acute ICH were investigated. Nutritional status was evaluated using the CONUT score, calculated from the serum albumin level, lymphocyte count, and total cholesterol level. Subsequent complications, such as hemorrhage expansion (HE) during the acute stage and aspiration pneumonia during hospitalization, were evaluated. Poor outcome was defined as a modified Rankin Scale score of ≥ 3 at 3 months. Of the 721 patients, 49 had HE, 111 had aspiration pneumonia, and 409 had poor outcomes. Patients with HE had significantly lower total cholesterol levels than those without HE. Patients with aspiration pneumonia had significantly lower albumin levels, lower lymphocyte counts, and higher CONUT scores than those without aspiration pneumonia. Patients with poor outcomes had significantly lower albumin levels, lower lymphocyte counts, lower total cholesterol levels, and higher CONUT scores than those with good outcomes. Multivariable logistic analysis showed that higher CONUT scores were independently associated with poor outcome (odds ratio, 1.28; 95% confidence interval, 1.09-1.49; P = 0.002) after adjusting for baseline characteristics, HE, and aspiration pneumonia. Each component of CONUT was a useful predictor of subsequent complications. Malnutrition, determined using the CONUT score, was independently associated with poor outcomes in patients with ICH after adjusting for these complications.
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Affiliation(s)
- Yuji Shiga
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Ryo Shimomura
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Kota Sato
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Takahiro Himeno
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Yuka Terasawa
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Naohisa Hosomi
- Department of Neurology, Chikamori Hospital, Kochi, Japan
- Department of Disease Model, Research Institute of Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Tatsuo Kohriyama
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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23
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Yamamoto K, Kurioka T, Ohki M, Ohashi K, Harada Y, Asako Y, Sano H, Yamashita T. Immune-Nutritional Status as a Novel Prognostic Predictor of Bell's Palsy. Audiol Neurootol 2022; 27:418-426. [PMID: 35512660 DOI: 10.1159/000524355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/23/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The prognosis of Bell's palsy, idiopathic facial nerve palsy (FNP), is usually predicted by electroneuronography in subacute phase. However, it would be ideal to establish a reliable and objective examination applicable in acute phase to predict the prognosis of FNP. Immune-nutritional status (INS) calculated from peripheral blood examination is recently reported as the prognostic factor in various disease. However, the validity of INS as the prognostic factor in Bell's palsy is not well known. Thus, we conducted a retrospective study to investigate the usefulness of INS as prognostic predictors of Bell's palsy. METHODS We reviewed the medical records of 79 patients with Bell's palsy and divided into two groups as "complete recovery" and "incomplete recovery" groups. Clinical features such as severity of FNP and INS, including neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), prognostic nutritional index (PNI), and controlling nutrition status (CONUT) score, were assessed. RESULTS In univariate analysis, statistically significant differences were observed in clinical score of facial movement, NLR, LMR, PNI, and CONUT score at the initial examination between the two groups (p < 0.05). Furthermore, in multivariate analysis, statistically significant differences were also observed in facial movement score and PNI at the initial examination (p < 0.05). CONCLUSION Immune and nutritional condition play important roles in the pathogenesis of Bell's palsy, suggesting that INS would be one of the useful prognostic factors in Bell's palsy.
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Affiliation(s)
- Kengo Yamamoto
- Department of Otorhinolaryngology, Kitasato University Medical Center, Kitamoto, Japan.,Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takaomi Kurioka
- Department of Otorhinolaryngology, National Defense Medical College, Tokorozawa, Japan
| | - Motofumi Ohki
- Department of Otorhinolaryngology, Kitasato University Medical Center, Kitamoto, Japan
| | - Kentaro Ohashi
- Department of Otorhinolaryngology, Kitasato University Medical Center, Kitamoto, Japan
| | - Yuki Harada
- Department of Otorhinolaryngology, Kitasato University Medical Center, Kitamoto, Japan.,Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yukiko Asako
- Department of Otorhinolaryngology, Kitasato University Medical Center, Kitamoto, Japan.,Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hajime Sano
- School of Allied Health Science, Kitasato University, Sagamihara, Japan
| | - Taku Yamashita
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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24
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Baseline Objective Malnutritional Indices as Immune-Nutritional Predictors of Long-Term Recurrence in Patients with Acute Ischemic Stroke. Nutrients 2022; 14:nu14071337. [PMID: 35405949 PMCID: PMC9000876 DOI: 10.3390/nu14071337] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/16/2022] [Accepted: 03/19/2022] [Indexed: 01/27/2023] Open
Abstract
Background: The controlling nutritional status (CONUT) score and the prognostic nutritional index (PNI) score were designed as indicators of patients’ immune-nutritional status. This study aimed to investigate the prognostic impact of the CONUT and PNI scores on long-term recurrent ischemic stroke (RIS) and adverse outcomes for adults with acute ischemic stroke (AIS). Methods: This retrospective study enrolled 991 AIS patients. Multivariable Cox regression models were used to assess the relationships of the malnutritional indices and RIS and major cardiovascular events (MACEs). Results: During a median follow-up at 44 months (IQR 39−49 months), 203 (19.2%) patients had RIS and 261 (26.3%) had MACEs. Compared with normal nutritional status, moderate to severe malnutrition was significantly related to an increased risk of RIS in the CONUT score (adjusted hazard ratio (HR) 3.472, 95% confidence interval (CI) 2.223−5.432, p < 0.001). A higher PNI value tertile (tertile two, adjusted HR 0.295, 95% CI 0.202−0.430; tertile three, adjusted HR 0.445, 95% CI 0.308−0.632, all p < 0.001) was related to a lower risk of RIS. Similar results were found for MACEs. The PNI exhibited nonlinear association with the RIS and both two malnutritional indices improved the model’s discrimination when added to the model with other clinical risk factors. Conclusions: This study demonstrated that the CONUT and PNI are promising, straightforward screening indicators to identify AIS patients with impaired immune-nutritional status at higher risk of long-term RIS and MACEs.
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25
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Li F, Li C, Sun Y, Bao Y, Jiang W, Song Z, Wang Y, Liu M, Wang W, Li T, Li L. Cerebral Ischemic Complications After Surgical Revascularization for Moyamoya Disease: Risk Factors and Development of a Predictive Model Based on Preoperative Nutritional Blood Parameters. Front Nutr 2022; 9:842838. [PMID: 35360692 PMCID: PMC8960452 DOI: 10.3389/fnut.2022.842838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Cerebral ischemic complications are common after revascularization in patients with moyamoya disease (MMD). Risk factors from specific laboratory variables have only been assessed by limited research. This study was to investigate the association between postoperative cerebral ischemia and nutritional blood parameters and examine predictive values of such risk factors in adults. Methods Preoperative demographics and nutritional blood parameters of patients with MMD who received revascularization at our institution from 2012 to 2021 were retrospectively reviewed. Univariate analysis and multivariable logistic regression were used to identify independent risk factors for the onset of postoperative cerebral ischemic complications. Predictive values were tested and a model incorporating these independent risk factors was created using the R program. Area under the receiver operating characteristic curve (AUC) was used for testing its discriminability. Results Postoperative cerebral ischemic complications occurred in 32 patients of 100 included procedures. Surgery on the left hemisphere, lower admission modified Rankin Scale (mRS) score, aberrant nutritional parameters including low white blood cell (WBC), and high total cholesterol (TC) were significantly associated with cerebral ischemic complications after revascularization. The intriguing role of WBC might be explained by altered immunomodulation. The AUC of this model with novel nutritional parameters yielded a value of 0.811, presenting better predictive accuracy. Additionally, the model was visualized in the form of a nomogram and translated into a user-friendly calculator to generate individual risk. Conclusions Surgical side, admission mRS score, WBC, and TC were independent risk factors for postoperative cerebral ischemic complications. The model composed of these four parameters was promising to be adopted in clinical practice.
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Affiliation(s)
- Fangbao Li
- Department of Neurosurgery, Qingdao Municipal Hospital, Qingdao, China
- School of Medicine, Dalian Medical University, Dalian, China
| | - Chuanfeng Li
- Department of Neurosurgery, Qingdao Municipal Hospital, Qingdao, China
| | - Yunwei Sun
- Department of Neurosurgery, Qingdao Municipal Hospital, Qingdao, China
| | - Yue Bao
- Department of Neurosurgery, Qingdao Municipal Hospital, Qingdao, China
| | - Wenbo Jiang
- Department of Neurosurgery, Qingdao Municipal Hospital, Qingdao, China
| | - Zuoyan Song
- Department of Anesthesiology, Qingdao Municipal Hospital, Qingdao, China
| | - Yongyi Wang
- Department of Neurosurgery, Qingdao Municipal Hospital, Qingdao, China
| | - Mingxing Liu
- Department of Neurosurgery, Qingdao Municipal Hospital, Qingdao, China
| | - Weimin Wang
- Department of Neurosurgery, Qingdao Municipal Hospital, Qingdao, China
| | - Tong Li
- Department of Neurosurgery, Qingdao Municipal Hospital, Qingdao, China
- *Correspondence: Tong Li
| | - Luo Li
- Department of Neurosurgery, Qingdao Municipal Hospital, Qingdao, China
- Luo Li
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Tang H, Gong F, Guo H, Dai Z, Wang J, Liu B, Li T, Tang X, Dong J, Pan S, Wang M, Sun Y, Qin B, Zhang J, Zhu X, Tian J, Fei Z, Lu G, Liu D. Malnutrition and Risk of Mortality in Ischemic Stroke Patients Treated With Intravenous Thrombolysis. Front Aging Neurosci 2022; 14:834973. [PMID: 35264946 PMCID: PMC8901046 DOI: 10.3389/fnagi.2022.834973] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/31/2022] [Indexed: 12/24/2022] Open
Abstract
Background and PurposeMalnutrition is highly prevalent in ischemic stroke patients. We aimed to investigate whether malnutrition indexes may be useful in predicting mortality at 90 days in ischemic stroke patients treated with intravenous thrombolysis.MethodsWe retrospectively analyzed consecutive patients who underwent thrombolytic therapy at three comprehensive stroke centers. Malnutrition was assessed using the controlling nutritional status (CONUT) score, geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI).ResultsOf 979 patients (mean age, 66.8 years; males, 63.6%) included in this study, 91 (9.3%; 95% confidence interval [CI]: 8.4–10.2%) died at 3-month follow up. According to the CONUT, GNRI, and PNI scores, 9.9, 33.7, and 7.0% of patients were moderately or severely malnourished, respectively; 64.0% were at least mildly malnourished by at least 1 malnutrition index. In the multivariate regression model after adjusting for potential confounders, malnutrition (severe risk versus normal nutritional status) was significantly associated with an increased risk of mortality for CONUT scores (adjusted odds ratio [OR] 16.16, 95%CI, 7.86-67.11; P < 0.001), GNRI scores (adjusted OR 9.82, 4.10-23.51; P < 0.001) and PNI scores (adjusted OR 12.74, 5.56-29.19; P < 0.001). Similar results were found when the malnutrition scores were analyzed as continuous variables. Adding the three malnutrition indexes to models containing conventional risk factors significantly improved risk reclassification for 3-month mortality.ConclusionOur study showed that malnutrition may be associated with a higher risk of mortality at 3 months in ischemic stroke after intravenous thrombolysis.
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Affiliation(s)
- Haiyan Tang
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fan Gong
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hongquan Guo
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Zheng Dai
- Department of Neurology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, China
| | - Jun Wang
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bin Liu
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Tingting Li
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xianbiao Tang
- Department of Rehabilitation Medicine, Puer Hospital of Traditional Chinese Medicine, Puer, China
| | - Junru Dong
- Changzhou Sports Medical Research Institute, Changzhou, China
| | - Song Pan
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, China
| | - Mingzhe Wang
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Sun
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Baofeng Qin
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jingsi Zhang
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuyin Zhu
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun Tian
- Department of Nursing, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhimin Fei
- Department of Neurosurgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Gendi Lu
- Department of Nursing, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Gendi Lu,
| | - Dezhi Liu
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Dezhi Liu,
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Huppertz V, Guida S, Holdoway A, Strilciuc S, Baijens L, Schols JMGA, van Helvoort A, Lansink M, Muresanu DF. Impaired Nutritional Condition After Stroke From the Hyperacute to the Chronic Phase: A Systematic Review and Meta-Analysis. Front Neurol 2022; 12:780080. [PMID: 35178021 PMCID: PMC8846185 DOI: 10.3389/fneur.2021.780080] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/09/2021] [Indexed: 12/25/2022] Open
Abstract
Background Malnutrition is common after stroke and can affect rehabilitation and healthcare costs. A comprehensive overview of stroke patients' nutritional condition from the hyperacute to the chronic phase is lacking. This systematic review aimed to investigate the prevalence of impaired nutritional condition (INC) across the continuum of care in specific phases after stroke. Methods CAB ABSTRACTS, Embase, MEDLINE, were used to collect studies published between 01-01-1999 and 26-08-2020. Primary and secondary outcomes were prevalence of INC and prevalence of malnutrition, respectively. Exploratory outcomes were prevalence of INC at follow-up, nutritional examination methods, prevalence of dysphagia, stroke severity, adverse events, and continent-specific prevalence of INC. A random-effects meta-analysis model was used to estimate the phase-specific pooled prevalence of INC and malnutrition. Results The dataset consisted of 78 study groups selected over a total of 1,244 identified records. The pooled prevalence of INC and malnutrition were 19% (95%CI:7–31) (N = 4) and 19% (95%CI:9–29) (N = 3), 34% (95%CI:25–43) (N = 34) and 26% (95%CI:18–35) (N = 29), 52% (95%CI:43–61) (N = 34) and 37% (95%CI:28–45) (N = 31), 21% (95%CI:12–31) (N = 3) and 11% (95%CI:0–24) (N = 3) and 72% (95%CI:41–100) (N = 3) and 30% (95%CI:0–76) (N = 2) in the hyperacute, acute, early subacute, late subacute, and chronic phase, respectively. Conclusion INC and malnutrition are highly prevalent in all stages of stroke care. Since malnutrition has been shown to negatively affect clinical outcomes, mortality, and overall healthcare expenditure in stroke survivors, it is essential to examine and monitor the nutritional status of stroke patients throughout their care journey to guide and plan, timely nutritional support and dietary modification.
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Affiliation(s)
- Viviënne Huppertz
- Department of Respiratory Medicine, Maastricht University, Maastricht, Netherlands
- *Correspondence: Viviënne Huppertz
| | - Sonia Guida
- Danone Nutricia Research, Utrecht, Netherlands
| | - Anne Holdoway
- DHealth, Consultant Dietitian, BMI/Circle Bath Clinic, Education Officer for the British Association for Parenteral and Enteral Nutrition and Chair of the UK Managing Adult Malnutrition in the Community Panel, Bath, United Kingdom
| | - Stefan Strilciuc
- Department of Neurosciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- “RoNeuro” Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Laura Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, and School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jos M. G. A. Schols
- Department of Health Services Research, Maastricht University, Maastricht, Netherlands
| | - Ardy van Helvoort
- Department of Respiratory Medicine, Maastricht University, Maastricht, Netherlands
- Danone Nutricia Research, Utrecht, Netherlands
| | | | - Dafin F. Muresanu
- Department of Neurosciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- “RoNeuro” Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
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Li T, Qi M, Dong G, Li X, Xu Z, Wei Y, Feng Y, Ren C, Wang Y, Yang J. Clinical Value of Prognostic Nutritional Index in Prediction of the Presence and Severity of Neonatal Sepsis. J Inflamm Res 2022; 14:7181-7190. [PMID: 34992413 PMCID: PMC8710072 DOI: 10.2147/jir.s343992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/08/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose The prognostic nutritional index (PNI) is a common indicator of nutritional and inflammatory status and is associated with various diseases such as cancer, cardiovascular diseases and infectious diseases. However, to date, no study has concentrated on the role of PNI in assessing and predicting the presence and severity of neonatal sepsis. Therefore, the present study aimed to explore the association of the PNI with the presence and severity of neonatal sepsis. Materials and Methods A total of 1196 neonates with suspected sepsis were enrolled in this study and their complete clinical and laboratory data were collected. PNI was calculated as serum albumin (g/L) + 5 × total lymphocyte count (109/L). Multivariate logistic regression analysis was performed to identify the risk factors for the presence and severity of neonatal sepsis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of PNI. All statistical analyses were performed using the statistical package SPSS 24.0. Results PNI was lower in neonates with sepsis and decreased significantly with the severity of sepsis. The correlation analysis demonstrated that the PNI was negatively correlated with the levels of the inflammatory marker procalcitonin (PCT) and C-reactive protein (CRP), and the length of hospital stay. Multivariate logistic regression analysis revealed that the PNI was independently and inversely associated with the presence and severity of neonatal sepsis. The area under the ROC curve of the PNI was 0.64 (95% confidence interval (CI): 0.61–0.67, P < 0.001) for severe sepsis and 0.69 (95% CI: 0.60–0.78, P < 0.001) for septic shock. In addition, our data revealed that PNI was also independently correlated with the length of hospital stay. Conclusion PNI is an independent predictor for the presence and severity of neonatal sepsis.
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Affiliation(s)
- Tiewei Li
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Minglu Qi
- Department of Emergency Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Geng Dong
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Xiaojuan Li
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Zhe Xu
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Yulei Wei
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Yichuang Feng
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Chong Ren
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Yaguo Wang
- Institute of Biophysics, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Junmei Yang
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
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Bayram M, Yildirim O, S Ozmen R, Soylu B, Dundar AS, Koksal AR, Ekinci I, Akarsu M, Tabak O. Prognostic Nutritional Index and CRP, age, platelet count, albumin level score in predicting mortality and intensive care unit admission for COVID-19. Biomark Med 2021; 15:1733-1740. [PMID: 34784756 PMCID: PMC8597666 DOI: 10.2217/bmm-2021-0337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Aim: In our study, we investigated the efficiency of the prognostic nutritional index (PNI) score and the CRP, age, platelet count, albumin level (CAPA) score predicting mortality and intensive care unit (ICU) admission in COVID-19 disease. Materials & methods: PNI and CAPA score of patients confirmed with COVID-19 calculated by using the complete blood count and biochemical parameters at admission to the hospital, in predicting the COVID-19-associated mortality and ICU admission were analyzed. Results: PNI and CAPA scores in predicting mortality were detected as AUC: 0.67 (p < 0.001), AUC: 0.71 (p < 0.001), respectively. For predicting ICU admission AUC was 0.66 (p < 0.001), AUC was 0.77 (p < 0.001), respectively. Conclusion: PNI and CAPA scores are effective scores in COVID-19, with CAPA score being better in predicting mortality and ICU admission.
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Affiliation(s)
- Mehmet Bayram
- Department of Gastroenterology, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
| | - Ozgur Yildirim
- Department of Internal Medicine, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
| | - Raye S Ozmen
- Department of Internal Medicine, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
| | - Beyza Soylu
- Department of Internal Medicine, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
| | - Ahmet S Dundar
- Department of Internal Medicine, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
| | - Ali R Koksal
- Department of Gastroenterology & Hepatology, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Iskender Ekinci
- Department of Internal Medicine, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
| | - Murat Akarsu
- Department of Internal Medicine, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
| | - Omur Tabak
- Department of Internal Medicine, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
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Zhao J, Liu K, Li S, Gao Y, Zhao L, Liu H, Fang H, Wu J, Sun S, Li Y, Song B, Xu Y. Prognostic nutritional index predicts clinical outcomes in patients with cerebral venous sinus thrombosis. BMC Neurol 2021; 21:404. [PMID: 34674659 PMCID: PMC8529735 DOI: 10.1186/s12883-021-02436-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022] Open
Abstract
Background Lower prognostic nutritional index (PNI) is related to the poor prognosis of cardiovascular diseases. However, little is known about PNI and its relationship with the prognosis of cerebral venous sinus thrombosis (CVST). Methods CVST patients were retrospectively identified from January 2013 till June 2019. Patients in the acute / subacute phase were selected as subjects. Poor prognosis was defined as a modified Rankin Scale (mRS) of 3–6. Multivariate logistic regression analysis was used to confirm if lower PNI was associated with a poor prognosis. Results A total of 297 subjects with follow-up data were enrolled. Thirty-three (11.1%) had a poor outcome. Multivariate logistic regression analysis suggested that PNI was an important predictive factor of poor outcome in acute/subacute CVST (odds ratio, 0.903; 95% CI, 0.833–0.978; P = 0.012). The optimal cut-off value for predicting the poor prognosis of PNI was 44.2. Kaplan-Meier analysis and log-rank test suggested that the lower the PNI value, the higher the mortality rate (P < 0.001). In addition, the nomogram that was set up showed that lower PNI was an index of poor prognosis. The c-index for acute/subacute patients with CVST was 0.872. Conclusion Lower PNI is correlated with a higher risk of adverse clinical outcomes in patients with acute/subacute CVST. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02436-w.
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Affiliation(s)
- Jiawei Zhao
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Kai Liu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Shen Li
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Yuan Gao
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Lu Zhao
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Hongbing Liu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Hui Fang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Jun Wu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Shilei Sun
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Yusheng Li
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Bo Song
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China.
| | - Yuming Xu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China.
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Protein energy wasting-based nutritional assessment predicts outcomes of acute ischemic stroke and solves the epidemiologic paradox. Nutrition 2021; 93:111431. [PMID: 34479047 DOI: 10.1016/j.nut.2021.111431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/10/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Overweight and hyperlipidemia, the two established risk factors for acute ischemic stroke, are paradoxically associated with favorable outcomes. The paradox may be resolved by the concept of protein energy wasting (PEW), in which total cholesterol level and body mass index are used as nutritional indexes for predicting outcomes of chronic kidney disease. METHODS Among 12 271 people with acute ischemic stroke and chronic kidney disease, 2086 were defined as being at risk of PEW-with a body mass index <22 kg/m2 plus either a serum albumin level <38 g/L or a total cholesterol level <4.14 mmol/L (160 mg/dL) without the use of lipid-lowering drugs-and all the others were a control group. The hazards of PEW for mortality and functional outcomes were evaluated using propensity score matching and multivariate Cox regression analysis. RESULTS Based on the propensity score, 2081 PEW participants were matched to the same number of non-PEW control participants. PEW was associated with a higher mortality risk at 3 mo (adjusted hazard ratio, 1.19; 95% confidence interval [CI], 1.02-1.42) and 1 y (adjusted hazard ratio, 1.33; 95% CI1.13-1.52). PEW was also associated with poor functional outcomes (modified Rankin Scale score >2) at 1 mo (adjusted odds ratio, 1.32; 95% CI, 1.08-1.61) and 3 mo (adjusted odds ratio, 1.27; 95% CI, 1.03-1.56). CONCLUSIONS According to the PEW-based assessment system, a modest decrease in body mass index and total cholesterol levels suggests malnutrition and is associated with adverse outcomes of acute ischemic stroke.
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Çınar T, Hayıroğlu Mİ, Çiçek V, Kılıç Ş, Asal S, Yavuz S, Selçuk M, Yalçınkaya E, Keser N, Orhan AL. Is prognostic nutritional index a predictive marker for estimating all-cause in-hospital mortality in COVID-19 patients with cardiovascular risk factors? Heart Lung 2021; 50:307-312. [PMID: 33482433 PMCID: PMC7832700 DOI: 10.1016/j.hrtlng.2021.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/25/2020] [Accepted: 01/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND This study examined the possible association between the prognostic nutritional index (PNI) and in-hospital mortality rates in cases with a high cardiovascular risk burden and hospitalized with the diagnosis of coronavirus disease 2019 (COVID-19). MATERIAL AND METHODS This retrospective and cross-sectional study included 294 COVID-19 patients hospitalized in a tertiary referral pandemic center. The study cohort was grouped into tertiles based on the initial PNI values as T1, T2, and T3. The PNI was calculated for each case and the prognostic value of this index was compared to CURB-65 and 4C mortality risk scores in predicting in-hospital mortality. RESULTS Patients stratified into the T1 tertile had a lower lymphocyte count, serum albumin level, and PNI values. In a multivariate analysis, the PNI (OR: 0.688,%95CI: 0.586-0.808, p < 0.001) was an independent predictor for all-cause in-hospital death. After adjusting for confounding independent parameters, patients included in the T1 tertile were found to have 11.2 times higher rates of in-hospital mortality compared to the T3 group, which was presumed as the reference group. In addition, we found that the area under curve (AUC) value of PNI was significantly elevated than that of serum albumin level and total lymphocyte counts alone. [(AUC):0.79 vs AUC:0.75 vs AUC:0.69; respectively). CONCLUSION This study demonstrated that the PNI is independently related with in-hospital mortality in patient with COVID-19 and cardiovascular risk factors. The power of the PNI was also validated using well-accepted risk scores of COVID-19 such as CURB-65 and 4C mortality risk scores.
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Affiliation(s)
- Tufan Çınar
- Sultan 2. Abdülhamid Han Training and Research Hospital, Department of Cardiology, Health Science University, Tibbiye Street, Uskudar, Istanbul, Turkey.
| | - Mert İlker Hayıroğlu
- Dr. Siyami Ersek Training and Research Hospital, Department of Cardiology, Health Science University, Istanbul, Turkey
| | - Vedat Çiçek
- Sultan 2. Abdülhamid Han Training and Research Hospital, Department of Cardiology, Health Science University, Tibbiye Street, Uskudar, Istanbul, Turkey
| | - Şahhan Kılıç
- Sultan 2. Abdülhamid Han Training and Research Hospital, Department of Cardiology, Health Science University, Tibbiye Street, Uskudar, Istanbul, Turkey
| | - Süha Asal
- Sultan 2. Abdülhamid Han Training and Research Hospital, Department of Cardiology, Health Science University, Tibbiye Street, Uskudar, Istanbul, Turkey
| | - Samet Yavuz
- Sultan 2. Abdülhamid Han Training and Research Hospital, Department of Cardiology, Health Science University, Tibbiye Street, Uskudar, Istanbul, Turkey
| | - Murat Selçuk
- Sultan 2. Abdülhamid Han Training and Research Hospital, Department of Cardiology, Health Science University, Tibbiye Street, Uskudar, Istanbul, Turkey
| | - Emre Yalçınkaya
- Sultan 2. Abdülhamid Han Training and Research Hospital, Department of Cardiology, Health Science University, Tibbiye Street, Uskudar, Istanbul, Turkey
| | - Nurgül Keser
- Sultan 2. Abdülhamid Han Training and Research Hospital, Department of Cardiology, Health Science University, Tibbiye Street, Uskudar, Istanbul, Turkey
| | - Ahmet Lütfullah Orhan
- Sultan 2. Abdülhamid Han Training and Research Hospital, Department of Cardiology, Health Science University, Tibbiye Street, Uskudar, Istanbul, Turkey
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