1
|
Kimura Y, Suzuki Y, Abe M. Association between the initial physical activity and functional recovery after 1 month of inpatient rehabilitation for subacute stroke: stratified analysis by nutritional status. Int J Rehabil Res 2024; 47:103-109. [PMID: 38618657 DOI: 10.1097/mrr.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Objectively measured physical activity volume serves as a predictive factor for functional recovery in patients with stroke. Malnutrition, a frequent complication of stroke, may influence the relationship between physical activity and functional recovery. This study aimed to examine the association between physical activity volume and functional recovery in patients with stroke, stratified by their nutritional status. This multicenter prospective observational study included 209 patients with stroke admitted to two Japanese convalescent rehabilitation hospitals. Participants were categorized based on the geriatric nutritional risk index (GNRI) at admission [≥92, high GNRI group ( n = 133); <92, low GNRI group ( n = 76)]. Physical activity levels were measured as the duration of total physical activity (TPA), which is the sum of light-intensity physical activity and moderate-to-vigorous physical activity, using a triaxial accelerometer during the first 7 days after admission. Outcome measures are represented as the relative gain of the motor score on functional independence measure (M-FIM effectiveness) during the first month after admission. The multiple regression analysis, adjusting for age, sex, comorbidity, onset to admission intervals, motor paralysis, initial M-FIM, and cognitive FIM, showed that the duration of TPA in the first 7 days was significantly associated with the M-FIM effectiveness over the first month in both low GNRI [ B = 0.12, 95% confidential intervals (CI) = 0.01; 0.24, P = 0.049] and high GNRI group ( B = 0.11, 95% CI = 0.01; 0.21, P = 0.027). This study demonstrates a positive predictive association between early TPA level and functional recovery in stroke patients, irrespective of their nutritional status.
Collapse
Affiliation(s)
- Yosuke Kimura
- Department of Science and Engineering, Health Science and Technology Course, Kanto Gakuin University, Yokohama
- HEalth Promotional Physical Therapy for Stroke Survivors: HEPPS, Strategic Issues Resolution Commission, Japanese Society of Neurological Physical Therapy
| | - Yoshiki Suzuki
- Department of Rehabilitation, Tokyo Shinjuku Medical Center, Japan Community Health Care Organization
| | - Marie Abe
- Department of Rehabilitation, Minamino Hospital, Eiseikai Association, Tokyo, Japan
| |
Collapse
|
2
|
Koca AN, Acehan S, Satar S, Gulen M, Sevdimbas S, Gorur M, Ozturk İ. Which one predicts mortality better in acute ischemic stroke: negative vs positive acute-phase reactants. Neurol Res 2024; 46:516-524. [PMID: 38555525 DOI: 10.1080/01616412.2024.2337513] [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: 11/15/2023] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
AIM The aim of the study is to investigate the relationship between negative acute-phase reactants and positive acute-phase reactants with in-hospital mortality in patients diagnosed with acute ischemic stroke (AIS) in the emergency department (ED). METHODS AND MATERIALS Patients aged 18 and older who presented to the ED of a tertiary hospital with AIS were included in the study. Demographic and clinical characteristics, laboratory parameters, acute-phase reactants, National Institutes of Health Stroke Scale (NIHSS), and outcome data of the included patients were recorded on a standard data form. RESULTS A total of 588 patients were included in the study. When the in-hospital mortality of patients was examined, the mortality rate was 17.7%. In the analysis for predicting mortality, it was determined that albumin had the highest predictive power between the area under the curve (AUC) and the determined predictive values (AUC: 0.759, 95% CI 0.707-0.810, p < 0.001). The analyses of the study data revealed that albumin (<0.001) and TF (p = 0.049), which are negative acute-phase reactants, were independent predictors of mortality. According to our study data, in patients with AIS, for each unit decrease in albumin level at the time of ED admission, the risk of mortality increased by 0.868 times, and for each unit decrease in TF level, the risk of mortality increased by 0.593 times. CONCLUSION According to the study data, albumin and TF levels, which are negative acute-phase reactants, are independent determinants of in-hospital mortality in patients with acute ischemic stroke in the emergency department.
Collapse
Affiliation(s)
- Ahmet Naci Koca
- Department of Emergency Medicine, Ministry of Health Samandag Hospital, Hatay, Turkey
| | - Selen Acehan
- Adana City Training and Research Hospital, Emergency Medicine Clinic, Health Sciences University, Adana, Turkey
| | - Salim Satar
- Adana City Training and Research Hospital, Emergency Medicine Clinic, Health Sciences University, Adana, Turkey
| | - Muge Gulen
- Adana City Training and Research Hospital, Emergency Medicine Clinic, Health Sciences University, Adana, Turkey
| | - Sarper Sevdimbas
- Adana City Training and Research Hospital, Emergency Medicine Clinic, Health Sciences University, Adana, Turkey
| | - Mehmet Gorur
- Adana City Training and Research Hospital, Emergency Medicine Clinic, Health Sciences University, Adana, Turkey
| | - İlker Ozturk
- Adana City Training and Research Hospital, Department of Neurology, Health Sciences University, Adana, Turkey
| |
Collapse
|
3
|
Li F, Zhao Y, Wang J, Chen J, Wang M, Hu W, Zhang B. The Impact of Modified Body Mass Index on Clinical Prognosis in the Elderly With Acute Ischemic Stroke. Neurologist 2024:00127893-990000000-00132. [PMID: 38679962 DOI: 10.1097/nrl.0000000000000562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
OBJECTIVES The modified body mass index (mBMI) combines the body mass index and serum albumin, accurately reflecting the nutritional status. It remains uncertain whether modified body mass index influences neurological function and clinical prognosis in elderly patients with acute ischemic stroke. METHODS We divided the cohort into quartiles of mBMI (1 to 4). The primary outcome was analyzed using the percentage of patients with a 90-day modified Rankin scale (mRS) score of 0 to 1. There were 7 secondary outcomes, including the disability level at 90 days and the National Institute of Health Stroke Scale (NIHSS) score at 14 and 90 days. RESULTS mBMI was negatively associated with clinical prognosis at 90-day mRS score in the primary outcome (β=-0.167; 95% CI -0.311 to 0.023, P=0.023). Moreover, mBMI1 (<896.72) and primary outcomes (β=0.438; 95% CI: -0.018 to 0.894) were positively correlated with higher mBMI. Moreover, the number and percentage of patients completing all the duties and activities are also higher. Age-adjusted Charlson comorbidity index (aCCI) and posterior circulation lesion were positively associated with the clinical prognosis 90-day mRS score in the primary outcome (β=2.218; 95% CI: 1.144-4.300, β=2.771; 95% CI: 1.700-4.516). However, BMI and serum albumin were not associated the with clinical prognosis primary outcome. BMI negatively correlates with secondary outcomes (NIHSS at discharge, β=-0.023; 95% CI: -0.102 to 0.057). CONCLUSIONS Our study revealed that mBMI and not BMI could be a better primary outcome predictor in the elderly with acute ischemic stroke, and lower mBMI showed a worse prognosis.
Collapse
Affiliation(s)
- Feng Li
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine
- Department of Neurology, Jiangsu Provincial Medical Key Discipline (Laboratory), Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School
| | - Yan Zhao
- Institute of Medical Imaging and Artificial Intelligence
| | - Jing Wang
- Institute of Brain Science, Nanjing University
| | - Jiu Chen
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University
- Jiangsu Key Laboratory of Molecular Medicine, Nanjing
| | - Maoxue Wang
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University
- Jiangsu Key Laboratory of Molecular Medicine, Nanjing
| | - Wenxia Hu
- Department of Neurology, Jiangsu Provincial Medical Key Discipline (Laboratory), Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School
| | - Bing Zhang
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University
- Jiangsu Key Laboratory of Molecular Medicine, Nanjing
- Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an People's Hospital of An Hui Province, Lu'an
- Graduate School of Bengbu Medical College, Bengbu, China
| |
Collapse
|
4
|
Jong SC, Fuentes JA, Seow AEQ, Lim CJ, Chandran G, Chua KSG. Effect of body mass index on inpatient rehabilitation outcome after stroke in a Southeast Asian cohort: a prospective study. Singapore Med J 2024; 65:223-228. [PMID: 34717300 PMCID: PMC11132619 DOI: 10.11622/smedj.2021190] [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: 02/27/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We examined the association between admission body mass index (BMI) and discharge rehabilitation functional outcome using the functional independence measure (FIM) in a Southeast Asian cohort of stroke patients during inpatient rehabilitation. METHODS A prospective, observational cohort study of stroke patients admitted to a single inpatient rehabilitation unit was conducted. Using the World Health Organization Asian standards, BMI was classified as underweight (<18.5 kg/m 2 ), normal (18.5-22.9 kg/m 2 ) and overweight (≥23 kg/m 2 ). The primary outcome measure was discharge FIM, and secondary outcomes included FIM gain, FIM efficiency and FIM effectiveness. RESULTS Two hundred and forty-seven stroke subjects were enrolled. The mean age of the cohort was 59.48 (standard deviation [SD] 12.35) years; 64.4% ( n = 159) were male and 52.6% ( n = 130) had ischaemic stroke. The distributions of underweight, normal and overweight based on BMI on admission were 10.9% ( n = 27), 33.2% ( n = 82) and 55.9% ( n = 138), respectively, and the distributions upon discharge were 11.7% ( n = 29), 38.1% ( n = 94) and 50.2% (n = 124), respectively. Significant small decreases in BMI from admission to discharge were found (median [interquartile range] 23.58 [23.40-24.70] vs. 23.12 [22.99-24.21]; P < 0.001). Similarly, clinically significant FIM gains (mean ΔFIM 26.71; 95% confidence interval 24.73, 28.69, P < 0.001) were noted after a median length of stay of 36 days. No significant relationships were found between BMI and discharge FIM ( P = 0.600), FIM gain ( P = 0.254), FIM efficiency ( P = 0.412) or FIM effectiveness ( P = 0.796). CONCLUSION Findings from this study unequivocally support the benefits of acute inpatient stroke rehabilitation. Patients in the obese BMI range tended to normalise during rehabilitation. Body mass index, whether underweight, normal or overweight, did not correlate with discharge FIM.
Collapse
Affiliation(s)
- Sze Chin Jong
- Division of Rehabilitation Medicine, University Medicine Cluster, National University Hospital, Singapore
| | | | | | - Chien Joo Lim
- Clinical Research and Innovation Office, Tan Tock Seng Hospital, Singapore
| | | | | |
Collapse
|
5
|
Cao C, Wang TB, Hu H, Han Y, Zhang X, Wang Y. Relationship between glycated hemoglobin levels and three-month outcomes in acute ischemic stroke patients with or without diabetes: a prospective Korean cohort study. BMC Neurol 2024; 24:85. [PMID: 38433248 PMCID: PMC10910674 DOI: 10.1186/s12883-024-03581-8] [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: 09/14/2023] [Accepted: 02/23/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVE In patients experiencing acute ischemic stroke, there is ongoing debate surrounding the connection between chronic hyperglycemic status and their initial clinical outcomes. Our objective was to examine the connection between glycated hemoglobin (HbA1c) levels and adverse clinical outcomes at both 3-months adverse clinical outcomes in individuals with acute ischemic stroke (AIS) with and without diabetes. METHODS The present prospective cohort study involved 896 AIS patients without diabetes and 628 with diabetes treated at a South Korean hospital from January 2010 to December 2016. The target independent variable is HbA1c. The outcome variable is a modified Rankin scale score ≥ 3. A binary logistic regression model was applied to assess the connection between HbA1c levels and 3-month poor clinical outcomes in AIS patients with and without diabetes. Additionally, a generalized additive model and smoothed curve fitting were utilized to explore potential nonlinear associations between HbA1c levels and 3-month adverse clinical outcomes in AIS patients with and without diabetes. RESULTS The binary logistic regression model could not identify any statistically significant connection between HbA1c and 3-month adverse clinical outcomes in AIS patients, both those with and without diabetes, after correcting for various factors. However, a nonlinear relationship emerged between HbA1c and 3-month adverse clinical outcomes in AIS patients with diabetes. The inflection point for HbA1c was determined to be 6.1%. For HbA1c values ≤ 6.1%, an inverse association was observed between HbA1c and 3-month adverse clinical outcomes in diabetic AIS patients, and each 1% increase in HbA1c in AIS patients with DM was associated with an 87% reduction in 3-month adverse clinical outcomes (OR = 0.13, 95% CI: 0.02-0.81). Conversely, when HbA1c exceeded 6.1%, a positive association between HbA1c and 3-month adverse clinical outcomes became apparent in diabetic AIS patients, and each 1% increase in HbA1c in AIS patients with DM was associated with a 23% increase in 3-month adverse clinical outcomes (OR = 1.23, 95%CI: 1.03-1.47). However, it's important to note that no significant linear or nonlinear relationships were observed between HbA1c levels and 3-month adverse clinical outcomes in AIS patients without diabetes. CONCLUSION Our findings suggest a nonlinear connection and threshold effect between HbA1c and 3-month adverse clinical outcomes in AIS patients with diabetes. AIS patients with diabetes had a lower risk of 3-month adverse clinical outcomes when their HbA1c control was close to 6.1%. Our findings may aid treatment decision-making and potentially guide interventions to optimize glycemic control in AIS patients.
Collapse
Affiliation(s)
- Changchun Cao
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, No. 6, Renmin Road, Dapeng New District, Shenzhen, 518000, Guangdong Province, China
- Department of Rehabilitation, Futian District, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, No.3002, Sungang West Road, Shenzhen, 518000, Guangdong Province, China
| | - Tony Bowei Wang
- Skidmore College, 815 North Broadway, Mailbox 8411, Saratoga Spring, NY, 12866-1632, USA
| | - Haofei Hu
- Department of Nephrology, Futian District, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, No.3002, Sungang West Road, Shenzhen, 518000, Guangdong Province, China
| | - Yong Han
- Department of Nephrology, Futian District, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, No.3002, Sungang West Road, Shenzhen, 518000, Guangdong Province, China.
- Department of Emergency, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518000, Guangdong Province, China.
| | - Xiaohua Zhang
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, No. 6, Renmin Road, Dapeng New District, Shenzhen, 518000, Guangdong Province, China.
| | - Yulong Wang
- Department of Rehabilitation, Futian District, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, No.3002, Sungang West Road, Shenzhen, 518000, Guangdong Province, China.
| |
Collapse
|
6
|
Eto F, Nezu T, Aoki S, Kuzume D, Hosomi N, Maruyama H. Liver fibrosis index is associated with functional outcome among acute ischemic stroke patients. J Stroke Cerebrovasc Dis 2024; 33:107537. [PMID: 38157700 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107537] [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] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION The fibrosis-4 (FIB-4) index and the fibrosis-5 (FIB-5) index are noninvasive markers of liver fibrosis in patients with nonalcoholic fatty liver disease. Although liver fibrosis a potential risk factor for stroke development, it is uncertain whether liver fibrosis influences stroke outcomes. We investigated the associations between these two indices and stroke patient outcomes and compared their predictive accuracy. METHODS We conducted a double-center, hospital-based, retrospective study. Consecutive acute ischemic stroke patients (n=2399) were analyzed. We calculated the FIB-4 index and the FIB-5 index and evaluated their relationships with poor stroke outcome, which was defined as a modified Rankin Scale score of 3-6 at three months after stroke. We evaluated the ability of each index to predict stroke outcome according to cutoff values calculated from receiver operating characteristic (ROC) curves. RESULTS Of 2399 recruited patients, 1549 patients (mean age, 73 years) were analyzed. The FIB-4 index and FIB-5 index had similar areas under their ROC curves for predicting stroke outcome (FIB-4 index, 0.675 and FIB-5 index, 0.683, P=0.334). The cutoff points of the FIB-4 index and FIB-5 index according to the ROC analysis were associated with poor stroke outcome in the multivariable analyses (odds ratio [OR] 2.23, 95 % confidence interval [CI] 1.72-2.89, OR 1.93, 95 % CI 1.47-2.54, respectively). CONCLUSIONS Liver fibrosis scores may be useful for predicting outcomes in patients with acute stroke. The FIB-4 and FIB-5 indices should be considered comprehensive tools for assessing the outcome risk after ischemic stroke.
Collapse
Affiliation(s)
- Futoshi Eto
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Daisuke Kuzume
- Department of Neurology, Chikamori Hospital, Kochi, 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
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
7
|
Kimura Y, Otobe Y, Suzuki M, Tanaka S, Kusumi H, Yamamoto S, Saegusa H, Yoshimura T, Yamada M. A U-shaped relationship between body mass index and functional recovery in older Japanese stroke survivors undergoing hospital rehabilitation. Clin Neurol Neurosurg 2023; 232:107881. [PMID: 37423090 DOI: 10.1016/j.clineuro.2023.107881] [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: 05/02/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE A relationship between body mass index and functional recovery in older survivors of stroke is unclear. Therefore, this study aimed to investigate the association of body mass index with post-stroke functional recovery in older Japanese stroke survivors undergoing hospital rehabilitation. METHODS This was a multicenter retrospective observational study of 757 older survivors of stroke, from six convalescent rehabilitation hospitals in Japan. The participants were classified into seven categories according to body mass index at admission. The measurements included outcomes of the absolute gain in the motor subscale of the Functional Independence Measure. Poor functional recovery was defined as gain < 17 points. Multivariate logistic regression analysis was performed to examine the impact of these body mass index categories on poor functional recovery. RESULTS The mean motor gains were highest in the 23.5-25.4 kg/m2 group (28.1 points), and lowest in the < 17.5 kg/m2 group (220.0 points). The results of the multivariate regression analyses (reference; 23.5-25.4 kg/m2 group) showed that the < 17.5 kg/m2 group (odds ratios 4.30; 95 % confidence intervals 2.09-8.87), the 17.5-19.4 kg/m2 group (1.99; 1.03-3.87), the 19.5-21.4 kg/m2 group (1.93; 1.05-3.54), and the ≥ 27.5 kg/m2 group (3.34; 1.33-8.42) were significantly associated with poor functional recovery, but not in the other groups. CONCLUSIONS Older survivors of stroke with high-normal weight had the most favorable functional recovery among the seven groups. Meanwhile, both low and extremely high body mass indexes were associated with poor functional recovery.
Collapse
Affiliation(s)
- Yosuke Kimura
- College of Science and Engineering, Health Science and Technology Course, Kanto Gakuin University, 1-50-1 Mutsuura East, Kanazawa-ku, Yokohama 236-8501, Japan.
| | - Yuhei Otobe
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, 3-7-30 Habikino, Habikino-city, Osaka 583-8555, Japan
| | - Mizue Suzuki
- Faculty of Allied Health Sciences, Yamato University, 2-5-1, Katayama-cho, Suita-shi, Osaka 564-0082, Japan
| | - Shu Tanaka
- Major of Physical Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, 5-23-22 Nishikamata, Ota-ku, Tokyo 144-8535, Japan
| | - Haruhiko Kusumi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Seiya Yamamoto
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Hiroki Saegusa
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Tomohiro Yoshimura
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Minoru Yamada
- Faculty of Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| |
Collapse
|
8
|
Shimizu S, Hanai T, Egashira Y, Sato Y, Sekiya K, Nishida S, Ishihara M, Ishihara T, Asada R, Kobayashi R, Suzuki A. Controlling nutritional status score during hospitalization as a predictor of clinical outcome in patients with aneurysmal subarachnoid hemorrhage. Sci Rep 2023; 13:12758. [PMID: 37550344 PMCID: PMC10406813 DOI: 10.1038/s41598-023-39938-1] [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: 01/16/2023] [Accepted: 08/02/2023] [Indexed: 08/09/2023] Open
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is a serious condition with high mortality and a high permanent disability rate. In this study, we examined the association of clinical outcome with the Controlling Nutritional Status (CONUT) score during hospitalization in aSAH patients. A single-center, retrospective observational study was conducted at Gifu University Hospital. Patients transported to the emergency room for aSAH and diagnosed with World Federation of Neurosurgical Societies (WFNS) grade III and IV aSAH between April 2004 and March 2021 were enrolled. A logistic regression model was constructed to evaluate the association of the CONUT score with a modified Rankin scale (mRS) ≥ 3 and delayed cerebral ischemia (DCI). 127 patients diagnosed with WFNS grade III and IV aSAH were analyzed. CONUT score was significantly associated with mRS ≥ 3 during hospitalization. The score obtained by subtracting the CONUT score at admission from the maximum CONUT score was significantly associated with mRS ≥ 3 at discharge. Moreover, the score obtained by subtracting the CONUT score at admission from the maximum CONUT score during the first 14 days was significantly associated with DCI within 14 days from admission. These findings indicate that CONUT score during hospitalization may be a useful daily marker for predicting poor outcomes in aSAH patients.
Collapse
Affiliation(s)
- Shinya Shimizu
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Tatsunori Hanai
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Yusuke Egashira
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yukina Sato
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Kumiko Sekiya
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Shohei Nishida
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masashi Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Japan
| | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Japan
| | - Ryuta Asada
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Japan
| | - Ryo Kobayashi
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
- Laboratory of Advanced Medical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Akio Suzuki
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
- Laboratory of Advanced Medical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan.
| |
Collapse
|
9
|
Godala M, Gaszyńska E, Walczak K, Małecka-Wojciesko E. Evaluation of Albumin, Transferrin and Transthyretin in Inflammatory Bowel Disease Patients as Disease Activity and Nutritional Status Biomarkers. Nutrients 2023; 15:3479. [PMID: 37571416 PMCID: PMC10421392 DOI: 10.3390/nu15153479] [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: 07/21/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023] Open
Abstract
Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), is often accompanied by malnutrition that manifests itself as nutrient deficiencies and body mass loss or deficit. The purpose of this study is to evaluate the utility of albumin, transferrin and transthyretin levels in the assessment of nutritional status and IBD activity. The case-control study included 82 IBD patients. The serum concentrations of albumin, transferrin and transthyretine were determined by a quantitative sandwich enzyme-linked immunosorbent assay (ELISA). Significantly lower median concentrations of albumin were found in the IBD patients vs. controls and in CD patients compared to the UC patients. Significantly higher median transthyretin concentrations were found in the IBD patients compared to the healthy subjects. There were no significant differences in median transferrin concentrations between the IBD patients and the healthy subjects. Significantly higher albumin levels were found in IBD patients in remission compared to patients with moderate and severe exacerbation of IBD symptoms. There were no significant differences in the median transferrin or transthyretin levels in patients with IBD depending on disease activity. No differences were identified in the median transferrin or transthyretin levels in the IBD patients according to nutritional status. The median albumin concentrations in the IBD subjects were significantly higher in patients with normal body fat, normal BMI and normal waist circumferences compared to those with an abnormal nutritional status. The albumin levels reflect both nutritional status and disease activity and therefore cannot be considered a prognostic marker of malnutrition in IBD. As regards the utility of transferrin and transthyretin as markers of activity and nutritional status in IBD patients, further studies are required.
Collapse
Affiliation(s)
- Małgorzata Godala
- Department of Nutrition and Epidemiology, Medical University of Lodz, 90-752 Lodz, Poland;
| | - Ewelina Gaszyńska
- Department of Nutrition and Epidemiology, Medical University of Lodz, 90-752 Lodz, Poland;
| | - Konrad Walczak
- Department of Internal Medicine and Nephrodiabetology, Medical University of Lodz, 90-419 Lodz, Poland;
| | - Ewa Małecka-Wojciesko
- Department of Digestive Tract Diseases, Medical University of Lodz, 90-647 Lodz, Poland;
| |
Collapse
|
10
|
Chen Y, Yang H, Lan M, Wei H, Chen Y. The controlling nutritional status score and risk factors associated with malnutrition in patients with acute ischemic stroke. Front Neurol 2023; 14:1067706. [PMID: 36970524 PMCID: PMC10033595 DOI: 10.3389/fneur.2023.1067706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
ObjectivesMalnutrition is an independent risk factor for poor outcomes in patients who suffered an acute ischemic stroke (AIS). The controlling nutritional status (CONUT) score can provide information for nutritional management in AIS patients. However, the risk factors associated with the CONUT score have not been established to date. Therefore, in this study, we aimed to investigate the CONUT score of patients with AIS and explore the potential risk factors associated with it.MethodsWe conducted a retrospective review of the data from consecutive AIS patients who were recruited in the CIRCLE study. Within 2 days of admission, we gathered the CONUT score, the Nutritional Risk Screening 2002, the Modified Rankin Scale, the National Institutes of Health Neurological Deficit Score (NIHSS), and demographic data from medical records. We used chi-squared tests to examine admission, and a logistic regression analysis was performed to explore the risk factors associated with CONUT in patients with AIS.ResultsA total of 231 patients with AIS participated in the study, with a mean age of 62.32 ± 13.0 years and a mean NIHSS of 6.77 ± 3.8. Of these patients, 41(17.7%) had hyperlipidemia. In terms of nutritional assessment, 137(59.3%) patients with AIS had high CONUT scores, 86(37.2%) patients with AIS had low or high BMI, and 117(50.6%) patients with AIS had NRS-2002 scores below 3. The chi-squared tests showed that age, NIHSS, body mass index (BMI), and hyperlipidemia were associated with the CONUT score (P < 0.05). The logistic regression analysis showed that low NIHSS scores (OR = 0.055 95% CI: 0.003–0.893), younger age (OR = 0.159 95% CI: 0.054–0.469), and hyperlipidemia (OR = 0.303 95% CI: 0.141–0.648) were independently associated with lower CONUT scores (P < 0.05), whereas BMI was not found to be independently associated with the CONUT.ConclusionsMore than half of the patients with AIS were at risk of malnutrition, with age and neurological deficits being identified as risk factors for nutritional control. Hyperlipidemia was found to be a protective factor of the CONUT, while NRS-2002 and BMI did not affect the nutritional control in patients with AIS.
Collapse
|
11
|
Lu HY, Ho UC, Kuo LT. Impact of Nutritional Status on Outcomes of Stroke Survivors: A Post Hoc Analysis of the NHANES. Nutrients 2023; 15:nu15020294. [PMID: 36678164 PMCID: PMC9864300 DOI: 10.3390/nu15020294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/19/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023] Open
Abstract
Stroke, a neurological emergency, is a leading cause of death and disability in adults worldwide. In acute or rehabilitative stages, stroke survivors sustain variable neurological recovery with long-term disabilities. The influence of post-stroke nutritional status on long-term survival has not been confirmed. Using the United States National Health and Nutrition Examination Survey data (2001−2010), we conducted a matched-cohort analysis (929 and 1858 participants in stroke and non-stroke groups, respectively) to investigate the influence of nutritional elements on post-stroke survival. With significantly lower nutrient consumption, the mortality risk was 2.2 times higher in stroke patients compared to non-stroke patients (Kaplan−Meier method with Cox proportional hazards model: adjusted hazard ratio, 2.208; 95% confidence interval: 1.887−2.583; p < 0.001). For several nutritional elements, the lower consumption group had significantly shorter survival than the higher consumption stroke subgroup; moreover, stroke patients with the highest 25% nutritional intake for each nutritional element, except moisture and total fat, had significantly shorter survival than non-stroke patients with the lowest 25% nutrition. Malnutrition is highly prevalent in stroke patients and is associated with high mortality rates. The dynamic change in energy requirements throughout the disease course necessitates dietary adjustment to ensure adequate nutritional intake.
Collapse
Affiliation(s)
- Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin 640, Taiwan
| | - Ue-Cheung Ho
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yunlin Branch, Yunlin 640, Taiwan
| | - Lu-Ting Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yunlin Branch, Yunlin 640, Taiwan
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
- Correspondence: ; Tel.: +886-2-2312-3456
| |
Collapse
|
12
|
Influence of Oxidative Stress and Inflammation on Nutritional Status and Neural Plasticity: New Perspectives on Post-Stroke Neurorehabilitative Outcome. Nutrients 2022; 15:nu15010108. [PMID: 36615766 PMCID: PMC9823808 DOI: 10.3390/nu15010108] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/13/2022] [Accepted: 12/18/2022] [Indexed: 12/28/2022] Open
Abstract
Beyond brain deficits caused by strokes, the effectiveness of neurorehabilitation is strongly influenced by the baseline clinical features of stroke patients, including a patient's current nutritional status. Malnutrition, either as a pre-stroke existing condition or occurring because of ischemic injury, predisposes patients to poor rehabilitation outcomes. On the other hand, a proper nutritional status compliant with the specific needs required by the process of brain recovery plays a key role in post-stroke rehabilitative outcome favoring neuroplasticity mechanisms. Oxidative stress and inflammation play a role in stroke-associated malnutrition, as well as in the cascade of ischemic events in the brain area, where ischemic damage leads to neuronal death and brain infarction, and, via cell-to-cell signaling, the alteration of neuroplasticity processes underlying functional recovery induced by multidisciplinary rehabilitative treatment. Nutrition strategies based on food components with oxidative and anti-inflammatory properties may help to reverse or stop malnutrition and may be a prerequisite for supporting the ability of neuronal plasticity to result in satisfactory rehabilitative outcome in stroke patients. To expand nutritional recommendations for functional rehabilitation recovery, studies considering the evolution of nutritional status changes in post-stroke patients over time are required. The assessment of nutritional status must be included as a routine tool in rehabilitation settings for the integrated care of stroke-patients.
Collapse
|
13
|
RDW-to-ALB Ratio Is an Independent Predictor for 30-Day All-Cause Mortality in Patients with Acute Ischemic Stroke: A Retrospective Analysis from the MIMIC-IV Database. Behav Neurol 2022; 2022:3979213. [PMID: 36567762 PMCID: PMC9780005 DOI: 10.1155/2022/3979213] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/21/2022] [Accepted: 09/10/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose Previous studies have shown that the peripheral red blood cell distribution width (RDW) and human serum albumin (ALB) were both predictors of the risk and mortality of cerebrovascular diseases, and the ratio of RDW to ALB (RAR) was a combined new index that can predict the prognosis of the cardiovascular and respiration systemic diseases, but its role in cerebrovascular diseases had not been effectively evaluated. This study is aimed at exploring whether RAR can effectively predict the 30-day all-cause mortality of acute ischemic stroke (AIS) patients. Methods This retrospective cohort study was conducted on AIS patients (age > 18 years) in the intensive care database MIMIC-IV. The RAR was measured based on the red blood cell distribution width and albumin. The main result was 30-day all-cause mortality, and the secondary results were ICU mortality and hospital mortality. Obtain the odds ratio (OR) estimate from the logistic regression model of log-transformed RAR values and mortality. We had used another database for external validation. Results A total of 1412 patients were enrolled, with an average age of 68.8 ± 15.9, including 708 (50.1%) males. When log-transformed RAR values were used as a continuous variable, as the values increases, the risk of death increases (30-day all-cause mortality OR = 4.02 (2.21, 7.32) P < 0.0001, ICU mortality OR = 3.81 (1.92, 7.54) P = 0.0001, and hospital mortality OR = 3.31 (1.83, 6.00) P < 0.0001), when the values were used as three-category variables and as a trend variable was also positively correlated with each mortality rate. Especially as the categorical variables, a dose-response relationship was clearly observed, that was, as the category of RAR increased (Q1 to Q3), the HR value of the risk of death gradually steadily increased. Such a relationship can also be observed in the external validation database. In the subgroup analysis, we observed an increased risk of death in the patient with hyperlipidemia and low HAS-BLED scores; however, no significant interaction was found in other subgroup analyses (including the diagnostic sequence of AIS). Conclusion RAR was a predictor of mortality in AIS patients. However, more in-depth research is needed to further analyze and confirm the role of RAR in AIS patients.
Collapse
|
14
|
Zan Y, Xiong W, Zhang X, Han Y, Cao C, Hu H, Wang Y, Ou H. Body mass index has a non-linear association with three-month outcomes in men with acute ischemic stroke: An analysis based on data from a prospective cohort study. Front Endocrinol (Lausanne) 2022; 13:1041379. [PMID: 36578955 PMCID: PMC9792146 DOI: 10.3389/fendo.2022.1041379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
Objective Despite reports of a connection between body mass index (BMI) and stroke outcome, the findings remain debatable. In this investigation, we sought to determine whether BMI was associated with the probability of 3-month unfavorable outcomes in patients with acute ischemic stroke (AIS). Methods This is a second analysis based on a cohort study. 1,897 people with AIS who were treated at a hospital in South Korea from January 2010 to December 2016 were included in the study. The linear relationship between BMI and unfavorable outcomes for AIS patients was evaluated using a binary logistic regression model. The generalized additive model (GAM) and smoothed curve fitting (penalized spline approach) were employed to see if there was a non-linear association between BMI and unfavorable outcomes in patients with AIS. Results The binary logistic regression model did not detect any statistically significant correlation between BMI and unfavorable outcomes in AIS patients after controlling for variables. The association between them, however, was non-linear, with the BMI inflection point occurring at 23.07 kg/m2. Each 1 kg/m2 rise in BMI on the left side of the inflection point was linked to a 12% lower risk of unfavorable outcomes (OR= 0.88, 95% CI: 0.82 to 0.96, p = 0.003). We stratified the AIS patients by gender to further explore their relationship. The results showed a specific non-linear relationship and saturation effect of BMI (kg/m2) with 3-month unfavorable outcomes in male patients but not in female patients. The inflection point for BMI was 23.35 kg/m2. When BMI was below 23.35 kg/m2 in men with AIS, BMI was inversely associated with unfavorable outcomes (OR=0.89,95% CI:0.80-0.98). Conclusion A particular non-linear connection and saturation effect between BMI (kg/m2) and 3-month unfavorable outcomes were present in male patients with AIS but not in females. 23.35 kg/m2 was the BMI's inflection point. The probability of unfavorable outcomes was substantially and inversely associated with BMI in men with AIS when it was less than 23.35 kg/m2. Men with AIS should have a BMI of no less than 23.35 kg/m2 to reduce the probability of unfavorable outcomes following AIS.
Collapse
Affiliation(s)
- Yibing Zan
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People’s Hospital, Shenzhen, Guangdong, China
- Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wei Xiong
- Department of Rehabilitation, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Xiaohua Zhang
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People’s Hospital, Shenzhen, Guangdong, China
| | - Yong Han
- Department of Emergency, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
| | - Changchun Cao
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People’s Hospital, Shenzhen, Guangdong, China
| | - Haofei Hu
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
| | - Yulong Wang
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People’s Hospital, Shenzhen, Guangdong, China
| | - Haining Ou
- Guangzhou Medical University, Guangzhou, Guangdong, China
| |
Collapse
|
15
|
Kamimoto T, Shindo K, Shimomura T, Akimoto T, Yamada T, Mori N, Nakao K, Tsujikawa M, Honaga K, Kutsuna T, Hiramatsu K, Kondo K, Liu M. Relationship between initial nutritional status and functional independence measures at discharge in subacute stroke. J Stroke Cerebrovasc Dis 2022; 31:106754. [PMID: 36115107 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 08/18/2022] [Accepted: 09/03/2022] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE This retrospective study examined the association between nutritional status at admission and functional independence measure (FIM™) at discharge. MATERIALS AND METHODS This study included 205 patients, aged ≥ 65, discharged from a convalescent ward between April 2017 and March 2018. The primary outcome was discharge FIMTM, and the secondary outcomes were the length of stay (LOS) and FIM efficiency. The explanatory variables included demographic data, stroke type, admission FIMTM, body mass index (BMI), controlling nutritional status (CONUT), and Geriatric Nutritional Risk Index (GNRI). Patients were divided into three groups based on BMI and GNRI scores and four groups based on the CONUT score. Univariate and multiple regression analyses were performed to predict discharge FIMTM. Kruskal-Wallis and Dunn's tests were also performed for intergroup comparisons. RESULTS In the univariate analyses, age, sex, onset-to-admission interval, admission FIMTM, GNRI, and BMI (all factors were p<0.001) were significant explanatory variables for discharge FIMTM. In the multiple linear regression analysis, admission FIMTM, LOS, age, and onset-to-admission interval were significant explanatory variables (adjusted R2 = 0.791; p<0.001). Although those with poor nutritional status required a longer hospital stay, they achieved the same FIM gain as those without poor nutritional status. CONCLUSIONS Nutritional status on admission did not affect the FIMTM at discharge in the convalescent ward. Patients with subacute stroke require adequate rehabilitation regardless of their nutritional status.
Collapse
Affiliation(s)
- Takayuki Kamimoto
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Keiichiro Shindo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, Hikarigaoka Hospital, Shirankai Medical Corporation Takaoka, Toyama, Japan.
| | - Tadasuke Shimomura
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, Saiseikai Yokohama-shi Tobu Hospital, Kanagawa, Japan.
| | - Tomonori Akimoto
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Yamada
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Naoki Mori
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, Hatsudai Rehabilitation Hospital, Tokyo, Japan.
| | - Keiko Nakao
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Oriental Medicine Research Center, Kitasato University, Tokyo, Japan.
| | - Masahiro Tsujikawa
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Kaoru Honaga
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Takeshi Kutsuna
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan.
| | - Kazuhisa Hiramatsu
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan.
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| |
Collapse
|
16
|
Weng SC, Hsu CY, Shen CC, Huang JA, Chen PL, Lin SY. Combined Functional Assessment for Predicting Clinical Outcomes in Stroke Patients After Post-acute Care: A Retrospective Multi-Center Cohort in Central Taiwan. Front Aging Neurosci 2022; 14:834273. [PMID: 35783145 PMCID: PMC9247545 DOI: 10.3389/fnagi.2022.834273] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Background and Objective In 2014, Taiwan’s National Health Insurance administration launched a post-acute care (PAC) program for patients to improve their functions after acute stroke. The present study was aimed to determine PAC assessment parameters, either alone or in combination, for predicting clinical outcomes. Methods We retrospectively enrolled stroke adult patients through one PAC network in central Taiwan between January 2014 and December 2020. We collected data on post-stroke patients’ functional ability at baseline and after PAC stay. The comprehensive assessment included the following: Modified Rankin Scale (MRS), Functional Oral Intake Scale (FOIS), Mini-Nutritional Assessment (MNA), Berg Balance Scale (BBS), Fugl-Meyer Assessment (FMA), Mini-Mental State Examination (MMSE), aphasia test, and quality of life. The above items were assessed first at baseline and again at discharge from PAC. Logistic regression was used to determine factors that were associated with PAC length of stay (LOS), 14-day hospital readmission, and 1-year mortality. Results A total of 267 adults (mean age 67.2 ± 14.7 years) with completed data were analyzed. MRS, activities of daily living (ADLs), instrumental activities of daily living (IADLs), BBS, and MMSE all had improved between disease onset and PAC discharge. Higher baseline and greater improvement of physical and cognitive functions between initial and final PAC assessments were significantly associated with less readmission, and lower mortality. Furthermore, the improved ADLs, FOIS, MNA, FMA-motor, and MMSE scores were related to LOS during PAC. Using logistic regression, we found that functional improvements ≥5 items [adjusted odds ratio (aOR) = 0.16; 95% confidence interval (CI) = 0.05–0.45] and improved MMSE (aOR = 0.19; 95% CI = 0.05–0.68) were significantly associated with reduced post-PAC mortality or readmission. Whereas, functional improvements ≥7 items, improved FOIS, and MNA significantly prolonged LOS during PAC. Conclusion Physical performance parameters of patients with acute stroke improved after PAC. PAC assessment with multiple parameters better predicted clinical outcomes. These parameters could provide information on rehabilitation therapy for acute stroke patients receiving PAC.
Collapse
Affiliation(s)
- Shuo-Chun Weng
- Department of Post-baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chiann-Yi Hsu
- Biostatistics Task Force of Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chiung-Chyi Shen
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jin-An Huang
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Po-Lin Chen
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Brain Science, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Yi Lin
- Institute of Clinical Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
- *Correspondence: Shih-Yi Lin,
| |
Collapse
|
17
|
Lee EC, Jeong YG, Jung JH, Moon HI. Validity of the Controlling Nutritional Status score as a Nutritional Assessment Tool early after stroke. Int J Rehabil Res 2022; 45:58-64. [PMID: 34726196 DOI: 10.1097/mrr.0000000000000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Malnutrition is relatively common in stroke survivors and it also affects weight loss and muscle strength. Various nutritional assessment tools have been used to monitor changes in nutritional status. Among such tools, the Controlling Nutritional Status (CONUT) score is a convenient and cost-effective index calculated from serum albumin level, total peripheral lymphocyte count, and total cholesterol level. This study investigated the prognostic role of malnutrition, as assessed by the CONUT scoring system. We hypothesized that malnutrition negatively affects outcomes as expressed by Functional Independence Measure (FIM) motor or Berg Balance Scale (BBS) change in stroke patients. This was a retrospective cohort study involving 117 individuals including first-time subacute stroke inpatients from March 2017 to February 2020. All participants were evaluated with BBS and FIM. We used multiple linear regression analysis with backward stepwise selection to examine the association between CONUT and changes during rehabilitation. After adjusting for independent predictors, we found the CONUT score to be associated with FIM motor (B = -1.848 ± 5.811, P < 0.001) and BBS change (B = -2.035 ± 0.424, P < 0.001). The present study showed that the malnutritional status calculated by the CONUT score at admission might help to predict the functional outcomes of stroke patients. The CONUT score is a comprehensive and feasible marker that could provide information for the nutritional management of stroke patients to significantly improve their clinical outcomes.
Collapse
Affiliation(s)
- Eun Chae Lee
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Bundang-gu, Seoungnam-si, Gyeonggi-do, Republic of Korea
| | | | | | | |
Collapse
|
18
|
Silva de Carvalho T, Singh V, Mohamud Yusuf A, Wang J, Schultz Moreira AR, Sanchez-Mendoza EH, Sardari M, Nascentes Melo LM, Doeppner TR, Kehrmann J, Scholtysik R, Hitpass L, Gunzer M, Hermann DM. Post-ischemic protein restriction induces sustained neuroprotection, neurological recovery, brain remodeling, and gut microbiota rebalancing. Brain Behav Immun 2022; 100:134-144. [PMID: 34848338 DOI: 10.1016/j.bbi.2021.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/26/2021] [Accepted: 11/22/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Moderate dietary protein restriction confers neuroprotection when applied before ischemic stroke. How a moderately protein-reduced diet influences stroke recovery when administered after stroke, is a clinically relevant question. This question has not yet been investigated. METHODS Male C57BL6/J mice were exposed to transient intraluminal middle cerebral artery occlusion. Immediately after the stroke, mice were randomized to two normocaloric diets: a moderately protein-reduced diet containing 8% protein (PRD) or normal diet containing 20% protein (ND). Post-stroke neurological deficits were evaluated by a comprehensive test battery. Antioxidant and neuroinflammatory responses in the brain and liver were evaluated by Western blot and RTqPCR. Stroke-induced brain injury, microvascular integrity, glial responses, and neuroplasticity were assessed by immunohistochemistry. Fecal microbiota analysis was performed using 16S ribosomal RNA amplicon sequencing. RESULTS We show that PRD reduces brain infarct volume after three days and enhances neurological and, specifically, motor-coordination recovery over six weeks in stroke mice. The recovery-promoting effects of PRD were associated with increased antioxidant responses and reduced neuroinflammation. Histochemical studies revealed that PRD increased long-term neuronal survival, increased peri-infarct microvascular density, reduced microglia/macrophage accumulation, increased contralesional pyramidal tract plasticity, and reduced brain atrophy. Fecal microbiota analysis showed reduced bacterial richness and diversity in ischemic mice on ND starting at 7 dpi. PRD restored bacterial richness and diversity at these time points. CONCLUSION Moderate dietary protein restriction initiated post-ischemic stroke induces neurological recovery, brain remodeling, and neuroplasticity in mice by mechanisms involving antiinflammation and, in the post-acute phase, commensal gut microbiota rebalancing.
Collapse
Affiliation(s)
- Tayana Silva de Carvalho
- Department of Neurology, University Hospital Essen, Essen, Germany; Center for Translational and Behavioral Neurosciences, University Hospital Essen, Essen, Germany
| | - Vikramjeet Singh
- Institute for Experimental Immunology and Imaging, University Hospital Essen, Essen, Germany
| | - Ayan Mohamud Yusuf
- Department of Neurology, University Hospital Essen, Essen, Germany; Center for Translational and Behavioral Neurosciences, University Hospital Essen, Essen, Germany
| | - Jing Wang
- Department of Neurology, University Hospital Essen, Essen, Germany; Center for Translational and Behavioral Neurosciences, University Hospital Essen, Essen, Germany
| | - Adriana R Schultz Moreira
- Department of Neurology, University Hospital Essen, Essen, Germany; Center for Translational and Behavioral Neurosciences, University Hospital Essen, Essen, Germany
| | - Eduardo H Sanchez-Mendoza
- Department of Neurology, University Hospital Essen, Essen, Germany; Center for Translational and Behavioral Neurosciences, University Hospital Essen, Essen, Germany
| | - Maryam Sardari
- Department of Neurology, University Hospital Essen, Essen, Germany; Center for Translational and Behavioral Neurosciences, University Hospital Essen, Essen, Germany; Department of Animal Biology, School of Biology, College of Science, University of Tehran, Tehran, Iran
| | - Luiza M Nascentes Melo
- Department of Neurology, University Hospital Essen, Essen, Germany; Center for Translational and Behavioral Neurosciences, University Hospital Essen, Essen, Germany
| | | | - Jan Kehrmann
- Institute of Medical Microbiology, University Hospital Essen, Essen, Germany
| | - Rene Scholtysik
- Institute of Cell Biology, University Hospital Essen, Essen, Germany
| | - Ludger Hitpass
- Institute of Cell Biology, University Hospital Essen, Essen, Germany
| | - Matthias Gunzer
- Institute for Experimental Immunology and Imaging, University Hospital Essen, Essen, Germany; Leibniz-Institut für Analytische Wissenschaften ISAS e.V, Dortmund, Germany
| | - Dirk M Hermann
- Department of Neurology, University Hospital Essen, Essen, Germany; Center for Translational and Behavioral Neurosciences, University Hospital Essen, Essen, Germany.
| |
Collapse
|
19
|
Hu Y, Wang J, Zeng S, Chen M, Zou G, Li Y, Zhu L, Xu J. Association Between Serum Albumin Levels and Diabetic Peripheral Neuropathy Among Patients with Type 2 Diabetes: Effect Modification of Body Mass Index. Diabetes Metab Syndr Obes 2022; 15:527-534. [PMID: 35228809 PMCID: PMC8881928 DOI: 10.2147/dmso.s347349] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/18/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The role of serum albumin in the risk of diabetic peripheral neuropathy (DPN) remains unclear. This study aimed to explore the relationship between serum albumin level and DPN, and to examine any possible effect modifiers among patients with type 2 diabetes mellitus. METHODS This cross-sectional study was conducted in Jiangxi, China, from May 2012 to December 2014. Serum albumin levels were determined in 523 subjects, and the association between serum albumin level and DPN was evaluated using linear regression models (odds ratio [OR] and corresponding 95% confidence interval [CI]). RESULTS There was a significant inverse association between serum albumin level (per 1 g/L increment, OR 0.95 [95% CI 0.92-0.98]) and the risk of DPN. Accordingly, when serum albumin was assessed as quartiles, a significantly lower risk of DPN was found in participants in quartile 4 (OR 0.49 [95% CI 0.25-0.95]), compared with those in quartile 1. Consistently, higher albumin levels (≥35 g/L) were associated with decreased odds for DPN (OR 0.36 [95% CI 0.17-0.74]) compared with lower levels. Furthermore, the albumin-DPN association was significantly stronger in patients with a relatively high body mass index (BMI; ≥24 kg/m2; OR 0.91 [95% CI 0.85-0.98]) than in those with a low BMI (<24 kg/m2; OR 0.99 [95% CI 0.94-1.04]; P for interaction = 0.042). CONCLUSION These data suggest that serum albumin level could be a novel risk factor for DPN among patients with type 2 diabetes and relatively high BMI (>24 kg/m2).
Collapse
Affiliation(s)
- Ying Hu
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, Jiangxi, 330006, People's Republic of China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, JIangxi, 330006, People's Republic of China
| | - Jiancheng Wang
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, Jiangxi, 330006, People's Republic of China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, JIangxi, 330006, People's Republic of China
| | - Sha Zeng
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, Jiangxi, 330006, People's Republic of China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, JIangxi, 330006, People's Republic of China
| | - Mengxia Chen
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, Jiangxi, 330006, People's Republic of China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, JIangxi, 330006, People's Republic of China
| | - Guilin Zou
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, Jiangxi, 330006, People's Republic of China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, JIangxi, 330006, People's Republic of China
| | - Yuxia Li
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, Jiangxi, 330006, People's Republic of China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, JIangxi, 330006, People's Republic of China
| | - Lingyan Zhu
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, Jiangxi, 330006, People's Republic of China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, JIangxi, 330006, People's Republic of China
| | - Jixiong Xu
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, Jiangxi, 330006, People's Republic of China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, JIangxi, 330006, People's Republic of China
- Correspondence: Jixiong Xu; Jiancheng Wang, Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng Street, Nanchang, Jiangxi, 330006, People’s Republic of China,Tel/Fax +86-791-86836960, Email ;
| |
Collapse
|
20
|
Prognostic role of the controlling nutritional status score in acute ischemic stroke among stroke subtypes. J Neurol Sci 2020; 416:116984. [DOI: 10.1016/j.jns.2020.116984] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/17/2022]
|
21
|
Lai KY, Wu TH, Liu CS, Lin CH, Lin CC, Lai MM, Lin WY. Body mass index and albumin levels are prognostic factors for long-term survival in elders with limited performance status. Aging (Albany NY) 2020; 12:1104-1113. [PMID: 31945744 PMCID: PMC7053589 DOI: 10.18632/aging.102642] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 12/23/2019] [Indexed: 12/13/2022]
Abstract
Elderly long-term care facility residents typically have musculoskeletal conditions that may lead to long-term disability and increased mortality. Our main objective was to explore the relationship between body mass index (BMI), albumin levels, and mortality in elderly individuals with limited performance status. Among 182 participants (mean age, 78.8 years; 57% women), 11%, 64%, and 25% had serum albumin levels of <2.8, 2.8-3.5, and >3.5 g/dL, respectively. After multivariate adjustments, diastolic blood pressure >90 mmHg was associated with all-cause mortality [hazard ratio (HR) = 2.08, 95% confidence interval (CI) = 1.13-3.82; P = 0.018]. In addition, BMI <18.5 kg/m2 and albumin level <2.8 g/dL associated with higher mortality than BMI = 18.5-24 kg/m2 and albumin level > 3.5 g/dL (HR = 1.80, 95% CI = 1.11-2.94 and HR = 2.54, 95% CI 1.22-5.30, respectively; P = 0.018 and 0.013, respectively). Highest mortality was noted in participants with albumin levels <2.8 g/dL and BMIs <18.5 kg/m2 (HR = 6.12, 95% CI = 1.85-20.21, P = 0.003). Combined hypoalbuminemia (albumin level < 2.8 g/dL) and low BMI (<18.5 kg/m2) may be a useful prognostic indicator of high mortality risk in elderly individuals with limited performance status.
Collapse
Affiliation(s)
- Kuan-Yu Lai
- Department of Family Medicine, China Medical University Hospital, Taichung City, Taiwan.,Department of Family Medicine, College of Medicine, China Medical University, Taichung City, Taiwan
| | - Tai-Hsien Wu
- Department of Family Medicine, China Medical University Hospital, Taichung City, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung City, Taiwan
| | - Chiu-Shong Liu
- Department of Family Medicine, China Medical University Hospital, Taichung City, Taiwan.,Department of Family Medicine, College of Medicine, China Medical University, Taichung City, Taiwan.,Department of Social Medicine, College of Medicine, China Medical University, Taichung City, Taiwan
| | - Chih-Hsueh Lin
- Department of Family Medicine, China Medical University Hospital, Taichung City, Taiwan.,Department of Family Medicine, College of Medicine, China Medical University, Taichung City, Taiwan
| | - Cheng-Chieh Lin
- Department of Family Medicine, China Medical University Hospital, Taichung City, Taiwan.,Department of Family Medicine, College of Medicine, China Medical University, Taichung City, Taiwan
| | - Ming-May Lai
- Department of Family Medicine, China Medical University Hospital, Taichung City, Taiwan.,Department of Family Medicine, College of Medicine, China Medical University, Taichung City, Taiwan
| | - Wen-Yuan Lin
- Department of Family Medicine, China Medical University Hospital, Taichung City, Taiwan.,Department of Family Medicine, College of Medicine, China Medical University, Taichung City, Taiwan.,Department of Social Medicine, College of Medicine, China Medical University, Taichung City, Taiwan
| |
Collapse
|
22
|
Factors associated with functional recovery in Japanese patients with convalescent stroke stratified by age: a multicenter observational study. Int J Rehabil Res 2019; 42:249-255. [DOI: 10.1097/mrr.0000000000000359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
23
|
Chen CM, Lee M, Yang YH, Huang SS, Lin CH. Association between Clinical and Laboratory Markers and 5-year Mortality among Patients with Stroke. Sci Rep 2019; 9:11521. [PMID: 31395912 PMCID: PMC6687732 DOI: 10.1038/s41598-019-47975-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/16/2019] [Indexed: 12/16/2022] Open
Abstract
Factors influencing long-term stroke mortality have not been comprehensively investigated. This study aimed to identify the baseline clinical, laboratory, demographic/socioeconomic, and hospital factors influencing 5-year mortality in patients with first stroke. Total 3,956 patients with first-stroke hospitalization from 2004 to 2008 were connected to the longitudinal National Health Insurance Research Database. Post-admission baseline data that significantly increased 5-year mortality were red cell distribution width (RDW) >0.145 (adjusted hazard ratio [aHR] = 1.71), hemoglobin <120 g/L (aHR = 1.25), blood sugar <3.89 mmol/L (70 mg/dL)(aHR = 2.57), serum creatinine >112.27 μmol/L (aHR = 1.76), serum sodium <134 mmol/L (aHR = 1.73), body mass index (BMI) < 18.5 kg/m2 (aHR = 1.33), Glasgow Coma Scale <15 (aHR = 1.43), Stroke Severity Index ≥20 (aHR = 3.92), Charlson–Deyo Comorbidity Index ≥3 (aHR = 4.21), no rehabilitation (aHR = 1.86), and age ≥65 years (aHR = 2.25). Hemoglobin, RDW, blood sugar, serum creatinine and sodium, BMI, consciousness, stroke severity, comorbidity, rehabilitation, and age were associated with 5-year mortality in patients with first stroke.
Collapse
Affiliation(s)
- Chien-Min Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan. .,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Meng Lee
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Shih-Shin Huang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chu-Hsu Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
24
|
Moderate Protein Restriction Protects Against Focal Cerebral Ischemia in Mice by Mechanisms Involving Anti-inflammatory and Anti-oxidant Responses. Mol Neurobiol 2019; 56:8477-8488. [PMID: 31257559 PMCID: PMC6835038 DOI: 10.1007/s12035-019-01679-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/10/2019] [Indexed: 12/02/2022]
Abstract
Food composition influences stroke risk, but its effects on ischemic injury and neurological deficits are poorly examined. While severe reduction of protein content was found to aggravate neurological impairment and brain injury as a consequence of combined energy-protein malnutrition, moderate protein restriction not resulting in energy deprivation was recently suggested to protect against perinatal hypoxia-ischemia. Male C57BL6/j mice were exposed to moderate protein restriction by providing a normocaloric diet containing 8% protein (control: 20% protein) for 7, 14, or 30 days. Intraluminal middle cerebral artery occlusion was then induced. Mice were sacrificed 24 h later. Irrespective of the duration of food modification (that is, 7–30 days), protein restriction reduced neurological impairment of ischemic mice revealed by a global and focal deficit score. Prolonged protein restriction over 30 days also reduced infarct volume, brain edema, and blood-brain barrier permeability and increased the survival of NeuN+ neurons in the core of the stroke (i.e., striatum). Neuroprotection by prolonged protein restriction went along with reduced brain infiltration of CD45+ leukocytes and reduced expression of inducible NO synthase and interleukin-1β. As potential mechanisms, increased levels of the NAD-dependent deacetylase sirtuin-1 and anti-oxidant glutathione peroxidase-3 were noted in ischemic brain tissue. Irrespective of the protein restriction duration, a shift from pro-oxidant oxidative stress markers (NADPH oxidase-4) to anti-oxidant markers (superoxide dismutase-1/2, glutathione peroxidase-3 and catalase) was found in the liver. Moderate protein restriction protects against ischemia in the adult brain. Accordingly, dietary modifications may be efficacious strategies promoting stroke outcome.
Collapse
|
25
|
Qi H, Yang X, Hao C, Zhang F, Pang X, Zhou Z, Dai J. Clinical Value of Controlling Nutritional Status Score in Patients with Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2019; 126:e1352-e1358. [DOI: 10.1016/j.wneu.2019.03.100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/10/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
|
26
|
Gao Q, Yuan F, Yang XA, Zhu JW, Song L, Bi LJ, Jiao ZY, Kang XG, Yang F, Jiang W. Development and validation of a new score for predicting functional outcome of neurocritically ill patients: The INCNS score. CNS Neurosci Ther 2019; 26:21-29. [PMID: 30968580 PMCID: PMC6930816 DOI: 10.1111/cns.13134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/16/2019] [Accepted: 03/20/2019] [Indexed: 11/29/2022] Open
Abstract
Aims To develop and validate a novel score for prediction of 3‐month functional outcome in neurocritically ill patients. Methods The development of the novel score was based on two widely used scores for general critical illnesses (Acute Physiology and Chronic Health Evaluation II, APACHE II; Simplified Acute Physiology Score II, SAPS II) and consideration of the characteristics of neurocritical illness. Data from consecutive patients admitted to neurological ICU (N‐ICU) between January 2013 and June 2016 were used for the validation. The modified Rankin Scale (mRS) was used to evaluate 3‐month functional outcomes. APACHE II scores, SAPS II scores, and our novel scores at 24 hours and 72 hours in N‐ICU were obtained. We compared the prognostic performance of our score with APACHE II and SAPS II. Results We developed a 44‐point scoring system named the INCNS score, and it includes 19 items which were categorized into five parts: inflammation (I), nutrition (N), consciousness (C), neurological function (N), and systemic function (S). We validated the INCNS score with a cohort of 941 N‐ICU patients. The 72‐hours INCNS score achieved an area under the receiver operating characteristic curve (AUC) of 0.828 (95% CI: 0.802‐0.854), and the 24‐hours INCNS score achieved an AUC of 0.788 (95% CI: 0.759‐0.817). The INCNS score exhibited significantly better discriminative and prognostic performance than APACHE II and SAPS II at both 24 hours and 72 hours in N‐ICU. Conclusion We developed an INCNS score with superior predictive power for functional outcome of neurocritically ill patients.
Collapse
Affiliation(s)
- Qiong Gao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Fang Yuan
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xi-Ai Yang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ji-Wen Zhu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lu Song
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Li-Jie Bi
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ze-Yu Jiao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiao-Gang Kang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Fang Yang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Wen Jiang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| |
Collapse
|
27
|
Naito H, Nezu T, Hosomi N, Aoki S, Kinoshita N, Kuga J, Shimomura R, Araki M, Ueno H, Ochi K, Maruyama H. Controlling nutritional status score for predicting 3-mo functional outcome in acute ischemic stroke. Nutrition 2018; 55-56:1-6. [DOI: 10.1016/j.nut.2018.02.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 01/30/2018] [Accepted: 02/13/2018] [Indexed: 11/16/2022]
|
28
|
Abstract
PURPOSE OF REVIEW To highlight the importance of nutrition in older adults undergoing a rehabilitation program. Geriatric rehabilitation aims at the recovery of physical abilities for a largely independent life in the community. The term 'geriatric rehabilitation' is wide and includes inpatient and ambulatory care as well as rehabilitation programs in hospitals, also outside geriatric wards. The role of nutrition is therefore not clearly defined, but an association between declined functional status and low nutritional status is evident. RECENT FINDINGS An association has been identified between malnutrition and low physical function or lower rehabilitation effect, respectively. In intervention trials with nutritional care (additional energy or protein), a number of benefits for muscle mass, muscle strength, physical function, or the outcomes quality of life and rehospitalization were identified. In this context, the combination of exercise and adequate nutrition seems to be beneficial. SUMMARY Geriatric patients undergoing a rehabilitation program outside inpatient, ambulatory, or hospitalization care need an adequate supply of energy and nutrients. Malnutrition must be avoided, ideally before starting rehabilitation. Nutritional interventions are most beneficial in combination with exercise training.
Collapse
Affiliation(s)
- Rebecca Diekmann
- Department for Health Services Research, Assistance Systems and Medical Devices, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | | |
Collapse
|