Improved Systemic Inflammation is Associated with Functional Prognosis in Post-Stroke Patients

Systemic inflammation is associated with gut microbiota diversity in post-stroke patients

BACKGROUND

There is growing interest in gut microbiota and health outcomes. However, the relationship between systemic inflammation and gut microbiota diversity in hospitalized patients remains unclear. This study aimed to investigate the association in post-stroke rehabilitation patients.

METHODS

A cross-sectional study was conducted on post-stroke patients admitted to a rehabilitation hospital. Systemic inflammation was assessed using the modified Glasgow Prognostic Score (mGPS). Gut microbiota diversity was evaluated using three indices: Shannon index, Operational Taxonomic Unit (OTU) richness, and Faith's Phylogenetic Diversity (PD). Multiple linear regression analyses were performed to examine the relationship between mGPS and gut microbiota diversity indices, adjusting for potential confounders.

RESULTS

A total of 156 patients (mean age 78.4 years; 55.7% men) were analyzed. The median mGPS was 0 (interquartile range: 0-1), with GPS distribution: 61.8% scored 0, 25.7% scored 1, and 12.5% scored 2. After adjusting for confounders, mGPS was significantly and negatively associated with the Shannon index (B = -0.143, 95% CI -0.288 to -0.002, β = -0.177) and OTU richness (B = -17.832, 95% CI -24.349 to -3.951, β = -0.208). However, no significant association was observed between mGPS and Faith's PD (B = -1.155, 95% CI -2.464 to 0.189, β = -0.155).

CONCLUSION

This study demonstrates a significant negative association between systemic inflammation and both quantitative and qualitative gut microbiota diversity in post-stroke patients.

Sex differences in sarcopenia prevalence and muscle-related outcomes among post-stroke inpatients

BACKGROUND

Sex differences in sarcopenia prevalence and recovery patterns among post-stroke patients remain poorly understood. This study aimed to investigate sex differences in sarcopenia prevalence, improvement rates, and changes in muscle-related indices among post-stroke patients in rehabilitation settings.

METHODS

A retrospective cohort study was conducted at a post-acute rehabilitation hospital. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia 2019 criteria. The primary outcomes were sarcopenia status and muscle-related indices (handgrip strength and skeletal muscle mass index) at discharge. Propensity score-adjusted logistic regression analysis was performed to examine the association between sex and non-sarcopenia at discharge.

RESULTS

A total of 598 patients (274 women) with a mean age of 71.6 years were analyzed. Women showed higher sarcopenia prevalence at admission compared to men (47.4% vs 34.2%, p = 0.001). After adjusting for confounders, male sex was positively associated with non-sarcopenia at discharge (OR 1.046, 95% CI 1.009-1.104, p < 0.001) and greater improvements in handgrip strength (B = 1.93, p = 0.031) and skeletal muscle mass index (B = 0.322, p = 0.019).

CONCLUSION

This study revealed significant sex differences in sarcopenia among post-stroke rehabilitation patients. While women showed higher sarcopenia prevalence at admission, men demonstrated better improvements in muscle-related outcomes.

Dual burden of sarcopenia and impaired oral status on activities of daily living, cognition and swallowing outcomes in post-stroke patients

BACKGROUND AND AIMS

Sarcopenia and poor oral health are common in older patients and are associated with negative outcomes. However, evidence of their combined impact on post-stroke rehabilitation outcomes is limited. This study aimed to investigate the combined impact of sarcopenia and impaired oral health on activities of daily living (ADL), cognition, and swallowing outcomes in post-stroke patients.

METHODS

A retrospective cohort study was conducted using 1,012 post-stroke patients (median age 75.6 years; 54.1 % men). Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia 2019 criteria. Poor oral health was assessed using the Revised Oral Assessment Guide (ROAG) with a score ≥13 indicating impaired oral status. Functional outcomes were measured using the Functional Independence Measure (FIM) for ADL and cognition, and the Food Intake Level Scale (FILS) for swallowing status.

RESULTS

The prevalence of sarcopenia was 45.6 % (492/1,080), impaired oral health was 27.5 % (297/1,080), and the coexistence of both conditions was 12.0 % (130/1,080). The coexistence of sarcopenia and impaired oral health was associated with poorer outcomes compared to either condition alone. After adjusting for confounders, the combination of sarcopenia and impaired oral status showed the strongest negative impact on FIM-motor (B=-8.666, 95 % CI -11.484 to -5.847), FIM-cognition (B=-1.122, 95 % CI -1.987 to -0.256), and FILS (B=-0.785, 95 % CI -1.055 to -0.514) scores at discharge.

CONCLUSION

The dual burden of sarcopenia and impaired oral health significantly impacts functional recovery in post-stroke patients. Comprehensive assessments and interventions targeting both conditions may optimize rehabilitation outcomes in this population.

The impact of palliative care on the frailty-stroke continuum: from theoretical concepts to practical aspects

With a constant increase in prevalence and incidence worldwide, stroke remains a public health issue in the 21st century. Additionally, population aging inevitably leads to increased vulnerability in the general population, a clinical state known as frailty. While there are adequate guidelines on the treatment of stroke in the acute setting, there are a lot of gaps regarding the chronic management of stroke patients, particularly the frail ones. From the therapeutic point of view, palliative care could be the key to offering complex and individualized treatment to these frail chronic stroke patients. In the context of the heterogeneous data and incomplete therapeutic guidelines, this article provides a new and original perspective on the topic, aiming to increase awareness and understanding and improve palliative care management in stroke patients. Based on current knowledge, the authors describe a new concept called the frailty-stroke continuum and offer a detailed explanation of the intricate stroke-frailty connection in the first part. After understanding the role of palliative care in managing this kind of patients, the authors discuss the most relevant practical aspects aiming to offer an individualized framework for daily clinical practice. The novel approach consists of developing a four-step scale for characterizing frail stroke patients, with the final aim of providing personalized treatment and correctly evaluating prognosis. By pointing out the limitations of current guidelines and the challenges of new research directions, this article opens the pathway for the better evaluation of frail stroke patients, offering a better perception of patients' prognosis.