Low admission serum albumin as prognostic determinant of 30-day case fatality and adverse functional outcome following acute ischemic stroke

Association between serum A/G ratio and stroke: data from NHANES 2009-2020

Background

The serum albumin-to-globulin ratio (A/G) has been widely used as a biomarker to assess inflammation, immunity, and nutritional status. However, relatively few studies have been conducted on the predictive value of serum A/G in stroke. Therefore, this study aimed to evaluate the correlation between serum A/G levels and stroke prognosis, to provide a new reference for risk assessment and management of stroke patients.

Methods

Data were sourced from the National Health and Nutrition Examination Survey (NHANES) for 2009-2020. The study utilized questionnaire responses and 24-h dietary recall interviews. Participants were stratified by serum albumin/globulin (A/G) ratios into tertiles. Multivariable logistic regression, curve fitting, subgroup analyses, and interaction tests were conducted to assess the associations with serum A/G ratios.

Results

Of the 82,298 participants initially considered, 52,119 had complete data and no history of stroke, albumin, or globulin deficiency, which were included in the analysis. We observed a decrease in stroke incidence with increasing A/G ratios. Higher A/G ratios were also associated with lower incidences of moderate exercise, diabetes, and coronary heart disease. The relationship between A/G ratios and stroke was moderated by covariates such as gender, hypertension, diabetes, smoking, and body mass index.

Conclusion

In the US population, serum A/G ratios positively correlate with stroke incidence. Serum A/G could be a simple and economical marker for identifying stroke risk in the population, though further prospective studies are required to validate these findings.

Eating difficulties among Nigerian community-dwelling stroke survivors: prevalence, correlates, and association with quality of life

BACKGROUND

Eating ability is central to human existence and survival, societal acceptance, life satisfaction, and social participation. Although eating difficulties (EDs) are common after stroke, few studies are reporting their impact on the quality of life (QoL) of stroke survivors. This study aimed to assess the prevalence, correlates, and association of EDs with QoL among stroke survivors.

METHODS

A cross-sectional study on 233 (Mean age: 59.6 ± 10.9 years; 52.8% female) Nigerian community-dwelling stroke survivors attending rehabilitation at three public hospitals was conducted. The Minimal Eating Observation Form- version II and WHOQOL-BREF were used to collect data on EDs and QoL respectively. Socio-demographic, stroke-related, and clinical characteristics of patients were assessed using structured questionnaires. The association of EDs with each domain of WHOQOL-BREF (physical health, psychological health, social relationships, environmental health, perceived health status, and overall QoL) was assessed with hierarchical regression analyses.

RESULTS

The majority (60.9%) of stroke survivors had at least one form of ED. Among the three types of EDs assessed, difficulty with energy/appetite (45.1%) was the most prevalent, followed by difficulty with ingestion (43.8%) and deglutition (40.8%). The results showed that EDs were associated with haemorrhagic stroke (r = 0.158; p = 0.016), right-sided hemiplegia (r = 0.172; p = 0.008), increasing stroke severity (r = 0.466; p < 0.001), increasing co-morbidity (r = 0.384; p < 0.001), poor oral health (r = 0.511; p < 0.001), poor mental health (r = 0.260; p < 0.001), poor affected grip strength (r= -0.157; p = 0.016), poor nutritional status (r= -0.362; p < 0.001), low functional ability (r= -0.415; p < 0.001), and low social support (r= -0.257; p < 0.001). After adjustments, EDs independently explained 10.7% of the variance in psychological health (β= -0.467; p < 0.001), 4.7% in social relationships (β= -0.308; p < 0.001), 2.4% in perceived health status (β= -0.221; p = 0.002), and 7.4% in overall QoL (β= -0.383; p < 0.001). However, the variance accounted for by EDs in physical and environmental health domains was insignificant.

CONCLUSION

The prevalence of EDs among Nigerian community-dwelling stroke survivors is high, which is associated with many stroke-related and clinical factors. Meanwhile, increasing in EDs is independently associated with reduced QoL among stroke survivors using WHOQOL-BREF. Emphasis on screening and management of EDs in stroke rehabilitation protocols may assist in improving survivors' QoL.

The predictive value of admission blood glucose to serum albumin ratio for futile recanalization after successful interventional recanalization in acute cerebral infarction with large vessel occlusion

Aims

We aim to explore the predictive value of admission blood glucose to serum albumin ratio (AAR) for futile recanalization after successful interventional recanalization of acute cerebral infarction.

Methods

We retrospectively collected the data of patients suffered from acute cerebral infarction due to anterior circulation large vessel occlusion and received successful interventional recanalization from January 2019 to November 2023. Statistical analysis of clinical data was conducted using SPSS 26.0.

Results

A total of 452 patients were included in the study. There were statistically significant differences in mRS score and futile recanalization rates among the three groups of patients at 3 months after surgery according to AAR tertile. In the multiple logistic regression analysis, there were statistically significant differences in Diabetes, grade of NIHSS score at admission, AAR tertiles, good collateral circulation and Pathogenesis. The Receiver Operating Characteristic curve (ROC) curve of AAR predicting futile recanalization was drawn with an AUC of 0.582 and a 95% confidence interval of 0.529-0.634. After combining grade of NIHSS score at admission, AAR tertiles and good collateral circulation, a ROC curve was drawn to predict futile recanalization, with an AUC of 0.907 and a 95% confidence interval of 0.879-0.936.

Conclusion

AAR is a new composite indicator for predicting futile recanalization in patients with acute cerebral infarction with anterior circulation large vessel occlusion. The combination of grade of NIHSS score at admission, AAR tertiles and good collateral circulation has a high predictive power for futile recanalization.

Clinical features and in-hospital mortality predictors of concurrent cardio-cerebral infarction: insights from a dual-center retrospective study

OBJECTIVE

This study aimed to enhance the understanding of cardio-cerebral infarction (CCI) clinical features and identify key prognostic factors, thereby providing an empirical foundation for advancing prevention and treatment strategies and ultimately improving clinical outcomes for CCI patients.

METHODS

We retrospectively analyzed 17,645 AIS and 7,584 AMI patients admitted to two hospitals from 2014 to 2023. Univariate analysis, Spearman correlation, and multivariate logistic regression were performed to identify independent risk factors. Receiver operating characteristic (ROC) curves were used to determine optimal cutoff values.

RESULTS

This study enrolled 85 patients with CCI, representing an overall CCI incidence of approximately 0.34%. Males comprised 64.71% of the cohort. ST-segment elevation myocardial infarction and cardiogenic cerebral infarction were the most predominant subtypes. The in-hospital mortality rate was 30.59%, with 65.38% of deaths attributed to cardiac causes. Multivariate logistic regression analysis identified three independent risk factors for in-hospital mortality: elevated neutrophil-to-lymphocyte ratio (NLR), decreased serum albumin, and increased peak N-terminal pro-B-type natriuretic peptide levels (NT-proBNP). ROC curve analysis demonstrated that the area under the curve (AUC) for the NLR, albumin concentration and peak NT-proBNP concentration were 0.863, 0.723, and 0.824, respectively. The optimal cutoff values were 6.914 for NLR, 33.80 g/L for albumin, and 9474.50 pg/mL for peak NT-proBNP. The AUC of the combined diagnostic model reached 0.959, significantly outperforming the individual indicators.

CONCLUSION

Elevated NLR, decreased serum albumin, and increased peak NT-proBNP levels independently predict in-hospital mortality in CCI patients. Combining these biomarkers enhances predictive capability for adverse outcomes.

Nutrition-associated markers and outcomes among patients receiving enteral nutrition after ischemic stroke: a retrospective cohort study

BACKGROUND

Early nutrition after acute ischemic stroke is crucial. We explored early enteral nutrition for stroke patients and evaluated changes in blood indicators as a predictor of stroke prognosis.

METHODS

All hospitalized stroke patients receiving enteral nutrition were included in the study. We retrospectively collected the protein, energy, fat, and carbohydrate values for 7 days after admission. Serum albumin, total protein, and hemoglobin values were reviewed at admission and at one week. The main outcome indicators were the Modified Rankin Score, Barthel Index, and Quality of Life at 3 months.

RESULTS

A total of 354 patients (mean age, 70.7 years; 59.0% male) were included. The change in serum albumin at day 7 relative to at admission was positively correlated with the Quality of Life score (p = 0.001), the Barthel Index (p = 0.004), and the modified Rankin Score (p = 0.029). The change in total protein at day 7 relative to at admission was positively correlated with the Quality of Life score (p = 0.002), the Barthel Index (p = 0.001), and the modified Rankin score (p = 0.011). The change in hemoglobin values at day 7 relative to at admission was positively correlated with the Barthel Index (p = 0.037 but not with the Quality of Life score (p = 0.237) or the modified Rankin score (p = 0.730).

CONCLUSIONS

Improved nutrition-related blood indicators one week after admission were independently associated with good stroke outcomes. Nutritional support for acute ischemic stroke patients during the early hospitalization stage appears to be advisable.

TRIAL REGISTRATION

This review was a retrospective cohort study. The study was retrospectively registered in the Chinese Clinical Trial Registry (No: ChiCTR2300077228). Registration date: 1/11/2023.

A nomogram model for predicting postoperative prognosis in patients with aneurysmal subarachnoid hemorrhage using preoperative biochemical indices

OBJECTIVE

The nutritional status and inflammatory responses of patients with aneurysmal subarachnoid hemorrhage (aSAH) play a vital prognostic role. We investigated the relationship between preoperative prognostic nutritional index (PNI)、neutrophil/albumin ratio (NAR)、platelet/albumin ratio (PAR) and other factors and the clinical prognosis of patients who underwent clipping for aSAH and its predictive model.

METHODS

The clinical data of 212 patients with aSAH who underwent neurosurgery at Nanyang Central Hospital between 2018 and 2023 were retrospectively analyzed. Based on the Glasgow Outcome Scale (GOS) score at 6 months postoperatively, the patients were categorized into two groups: poor (GOSI-III) and good (GOSIV-V) prognosis groups. Multivariate logistic regression analysis was performed to determine the predictive value of preoperative PNI、NAR、PAR、hyperlipidemia and Glasgow Coma Scale (GCS) for prognosis. Furthermore, nomograms and prognostic prediction models were constructed. Receiver operating characteristic curves and area under the curve (AUC) were utilized to determine the predictive values.

RESULTS

Multivariate logistic regression analysis revealed that PNI (OR = 1.250, 95%CI 1.060 ~ 1.475, P = 0.008), NAR (OR = 0.000, 95%CI 0.000 ~ 0.004, P = 0.000), PAR(OR = 0.515, 95%CI 0.283 ~ 0.937, P = 0.030), hyperlipidemia (OR = 4.627, 95%CI 1.166 ~ 18.367, P = 0.029), and GCS(OR = 1.446, 95%CI 1.041 ~ 2.008, P = 0.028) are independent risk factors for poor postoperative prognosis. The total score of the nomogram was 200, and the AUC value was 0.972.

CONCLUSIONS

PNI and NAR can reflect the nutritional status and inflammatory responses of patients.They are significantly associated with the postoperative prognosis of patients with aSAH. Comprehensively analyzing PNI and NAR combined with other clinical indicators can more effectively guide treatment and help predict prognosis.

Malnutrition elevates delirium and ICU stay among critically ill older adult COVID-19 patients

Background and aim

Malnutrition among intensive care unit (ICU) patients is associated with a higher risk of mortality and prolonged hospitalization. However, the influence of malnutrition on severe outcomes of ICU patients with coronavirus disease 2019 (COVID-19) is unclear. By evaluating the effect of malnutrition on the outcomes of COVID-19 in the ICU in older adult patients, this study will contribute to new knowledge of assessing the nutritional status and recovery of these patients.

Methods

In the current single center prospective study, 310 critically ill COVID-19 patients with an age range of ≥65 years were recruited. Data on demographic characteristics, laboratory parameters, comorbidities, medications, and types of mechanical ventilation were collected in the first 24 h of ICU admission. Malnutrition was defined based on the two-step approach of the Global Leadership Initiative on Malnutrition (GLIM) scale at baseline. During the 45 days after the baseline, we collected data on delirium incidence, mortality, invasive mechanical ventilation (IMV) requirement, length of ICU and hospital admission, and re-hospitalization.

Results

In this study, the prevalence of malnutrition was 63.4% among critically ill COVID-19 patients. During the 45-day follow-up, 190 (61.3%) COVID-19 deaths were recorded among the baseline 310 patients. After controlling for potential confounders, malnutrition was associated with an increased risk of delirium so malnourished COVID-19 patients had a significantly 35% higher risk of delirium than those without malnutrition (HR: 1.35, 95% CI: 1.01-1.83). Such a significant association was not for COVID-19 mortality and IMV requirement. In addition, malnutrition was associated with a significantly 84% greater odds of prolonged ICU admission (OR: 1.84, 95% CI: 1.09-3.10). No significant association was seen between malnutrition and re-hospitalization and also prolonged hospital admission.

Conclusion

Malnutrition was associated with an increased risk of delirium and prolonged ICU admission among critically ill older adult COVID-19 patients. Prevention, diagnosis, and treatment of malnutrition could be a key component in improving outcomes in these patients.

Ischemic Stroke Outcome Predicted by Serum Albumin Levels

OBJECTIVE AND AIM

 This research aims to assess the predictive importance of serum albumin levels in individuals who have recently experienced an acute ischemic stroke and to establish a correlation between these two variables.

MATERIALS AND METHODS

A prospective hospital-based investigation with 50 participants was conducted after receiving ethical approval from Sunshine Hospital, Hyderabad, India. Patients older than 18 years old who had radiological or clinical evidence of having suffered an acute ischemic stroke were considered for participation in the research.

RESULTS

 Albumin levels in the blood are typically about 3.6 g/dL. One patient between the ages of 46 and 55 had low serum albumin levels. Many people in both groups had albumin levels of about 4.4. Serum albumin concentration was measured using the modified Rankin Scale (mRS). After one week and three months, 32 patients had mRS values of less than three, whereas 16 had mRS values of greater than three-one; the individual presented with an mRS value over 3, as well as a blood albumin level below 3.5. The p-value ended up being 0.428. No link could be supported by the statistical evidence identified. P = 0.249 indicated no association between serum albumin and National Institutes of Health Stroke Scale (NIHSS) scores. According to the findings of this inquiry, there is no correlation between the amounts of albumin in the blood and the NIHSS scores.

CONCLUSION

This study did not find a correlation between higher blood albumin levels and a worse outcome after an ischemic stroke. It contradicts the corpus of current knowledge.

The lactate-to-albumin ratio relationship with all-cause mortality in cerebral infarction patients: analysis from the MIMIC-IV database

Objective

To examine the association of lactate-to-albumin ratio (LAR) with 30-day and 90-day mortality in patients with cerebral infarction admitted to the intensive care unit (ICU).

Methods

In this retrospective observational study, 1,089 patients with cerebral infarction were recruited. The concentration of blood lactate and serum albumin on the first day of ICU admission were recorded. The relationship between LAR levels and mortality was evaluated through univariate and multivariate Cox regression analyses, four-knot multivariate restricted cubic spline regression, and Kaplan-Meier (KM) curves.

Results

The overall 30-day and 90-day mortality rates in the entire cohort were 27.3 and 35.8%, respectively. KM analysis revealed a significant relationship between high LAR index and the risk of all-cause mortality (log-rank p < 0.001). Furthermore, multivariate Cox proportional risk analysis showed that the LAR index independently predicted the risk of 30-day mortality (HR: 1.38, 95% CI 1.15-1.64, p = 0.004) and 90-day mortality (HR: 1.53, 95% CI 1.32-1.77, p < 0.001) in the study population. Furthermore, a higher LAR exceeding 0.53 was positively correlated with the risk of 30-day and 90-day mortalities. Subsequent subgroup analyses demonstrated that LAR could predict the primary outcome.

Conclusion

In summary, the LAR index is a reliable and independent predictor of increased mortality among critically ill patients suffering from cerebral infarction. Nonetheless, there is a need for additional comprehensive prospective studies to validate these findings.

Association of red blood cell distribution width to albumin ratio with the prognosis of acute severe pulmonary embolism: A cohort study

Red blood cell distribution width (RDW) to human serum albumin (ALB) ratio (RDW/ALB Ratio, RAR) is a prognostic factor for adverse outcomes in different disease populations. However, the relationship between RAR and pulmonary embolism outcomes remains unclear. Therefore, this study set out to investigate the association between RAR and the risk of all-cause death in acute pulmonary embolism (APE) patients admitted to the intensive care unit (ICU). This is a retrospective study based on the MIMIC-IV database. The primary outcome was all-cause mortality among patients with APE (in-hospital and 1-year mortality). The relationship between RAR and all-cause mortality was assessed using Cox regression analysis. The survival curve was drawn to evaluate the predictive value of RAR for patient mortality. Correlations and threshold effects between RAR and all-cause mortality were analyzed using the generalized additive model (GAM). The study included 773 patients, and fully adjusted Cox regression models showed that RAR was associated with higher all-cause mortality in the hospital and one year later (all P < .05). In the GAM, the relationship between RAR and all-cause mortality was shown to be nonlinear, with a positive association between RAR and all-cause mortality in APE patients when RAR values were at low to moderate levels. This study revealed a significant association between RAR and the risk of all-cause day death in patients with pulmonary embolism. Higher RAR value was associated with increased in-hospital mortality and 1-year mortality.

Preoperative prognostic nutrition index can independently predict the 6-month prognosis of elderly patients undergoing neurosurgical clipping for aneurysmal subarachnoid hemorrhage

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.

Development and Validation of a Novel Nomogram to Predict Hypoalbuminemia among Patients with Stroke in the Neurocritical Care Unit

This study aimed to investigate hypoalbuminemia-related factors in patients with stroke in the neurocritical care unit (NCU) and to establish a nomogram model for hypoalbuminemia prediction. Data from 902 patients hospitalized for stroke in the NCU who had normal albumin levels on admission from March 2018 to December 2020 were analyzed. Logistic regression was used to identify the risk factors associated with hypoalbuminemia. A novel nomogram prediction model for hypoalbuminemia was constructed, and it was validated in an independent set (n = 233). The nomogram incorporated seven risk factors, including age, high comorbidity, mechanical ventilation, feeding routes, total protein, high-sensitivity C-reactive protein, and fibrinogen levels, and its area under the curve for predicting hypoalbuminemia in the developmental set and validation set were 0.856 and 0.870, respectively. The novel nomogram facilitates risk prediction of hypoalbuminemia among patients with stroke in the NCU, which might be useful for selecting treatment strategies and management.

The relationship between nutritional status at the time of stroke on adverse outcomes: a systematic review and meta-analysis of prospective cohort studies

CONTEXT AND OBJECTIVE

The impact of existing malnutrition on stroke outcomes is poorly recognised and treated. Evidence was systematically reviewed and quantified by meta-analysis.

METHODS

MEDLINE, EMBASE and Web of Science were searched from inception to 11 January 2021 and updated in July. Prospective cohort studies, in English, evaluating anthropometric and biomarkers of nutrition on stroke outcomes were included. Risk of bias was assessed using the Scottish Intercollegiate Guidelines Network checklist.

RESULTS

Twenty-six studies (n = 156 249) were eligible (follow-up: One month-14 years). Underweight patients had increased risk of long-term mortality (adjusted hazard ratio = 1.65,1.41-1.95), whilst overweight (0.80,0.74-0.86) and obese patients (0.80,0.75-0.85) had decreased risk compared to normal weight. Odds of mortality decreased in those with high serum albumin (odds ratio = 0.29,0.18-0.48) and increased with low serum albumin (odds ratio = 3.46,1.78-6.74) compared to normal serum albumin (30-35 g/L). Being malnourished compared to well-nourished, as assessed by the Subjective Global Assessment (SGA) or by a combination of anthropometric and biochemical markers increased all-cause mortality (odds ratio = 2.38,1.85-3.06) and poor functional status (adjusted odds ratio = 2.21,1.40-3.49).

CONCLUSION

Nutritional status at the time of stroke predicts adverse stroke outcomes.

Association between serum albumin and mortality in Japan older people with dysphagia

To determine whether there is a link between serum albumin and mortality among participants in the elderly in Japan. This is a single-center,retrospective cohort study analysis of 253 old patients with dysphagia from Japan, conducted from January 2014 to January 2017. The primary outcome was mortality. We performed Cox regression analysis to compare the mortality between the two groups (divided by serum albumin = 3 g/dl). 253 patients were included in the analysis, of whom the number of serum albumin under 3 g/dl was 93. The log-rank test showed a significant longer mortality in the high group (serum albumin >  = 3 g/dl) compared with the low group (median, 382 vs. 176 days, P < 0.0001). Cox regression analysis showed that unadjusted HR for the high group relative to the low group was 0.40 (95% CI: 0.29-0.57; P < 0.001). After adjusting 3 models in multivariable analysis, serum albumin was significantly associated with mortality. The adjusted HRs (95% CI) for total mortality rates were 0.46 (0.33-0.65), 0.66 (0.44-0.99) and 0.64 (0.42-0.97), from model 2 to model 4. There is negative association between serum albumin and mortality in Japanese old people with dysphagia.

Association Between Serum Albumin and Hospital-Acquired Infections After Aneurysmal Subarachnoid Hemorrhage

BACKGROUND

Low serum albumin levels have been identified as a predictor of infectious complications in critically ill patients. However, the association in patients with aneurysmal subarachnoid hemorrhage (aSAH) remains unclear. We aimed to evaluate the prognostic value of hypoalbuminemia using blood samples at admission in patients with aSAH.

METHODS

In a multicenter observational study of patients with aSAH, serum albumin counts were collected on admission. Hypoalbuminemia was defined as a total albumin level < 35 g/L. Multivariable logistic regression analyses and propensity score matching were performed to obtain the adjusted odds ratios (ORs) with 95% confidence intervals (CI) for the primary outcome of hospital-acquired infections.

RESULTS

A total of 5448 patients were included in the observational cohort study. The odds of hospital-acquired infections were significantly higher in patients with albumin levels 30-34.9 g/L (OR 1.62, 95% CI 1.38-1.90), 25-29.9 g/L (OR 1.97, 95% CI 1.54-2.51), and < 24.9 g/L (OR 2.43, 95% CI 1.53-3.86) compared with patients with albumin level ≥ 35 g/L. The odds of hospital-acquired infections with a change in albumin levels from admission to 48-72 h later of lower than - 10 g/L and - 10 to - 5 g/L were 1.67 (95% CI 1.41-1.86) and 1.24 (95% CI 1.05-1.46), respectively, compared with a change in albumin levels of - 5 to 5 g/L.

CONCLUSIONS

In this large study of matched patients with aSAH, hypoalbuminemia at admission was associated with hospital-acquired infections. A decrease in serum albumin levels within 72 h of admission was associated with higher hospital-acquired infections.

The Relationship of Malnutrition With Cognitive Function in the Older Chinese Population: Evidence From the Chinese Longitudinal Healthy Longevity Survey Study

Background and Objective: Few studies have explored the relationship between malnutrition measured by the Geriatric Nutritional Risk Index (GNRI) and cognitive performance. This study aimed to investigate the association of malnutrition with cognitive function in the Chinese population.

Methods: It was a prospective longitudinal study and used three waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data in 2011–2012, 2014, and 2017–2018. Participants aged 60 years or older without mental illness and cerebrovascular diseases were eligible. The GNRI was used to assess nutritional status as follows: normal nutrition (a GNRI > 98), mild malnutrition (92 ≤ a GNRI ≤ 98), and moderate-to-severe malnutrition (a GNRI < 92). Cognitive performance was evaluated by the Mini-Mental State Examination (MMSE) scores. The relationship between the GNRI and cognitive function was analyzed using a linear mixed-effects model.

Results: A total of 1,632 subjects were analyzed, including 741 males and 891 females. Of these, 65.0, 19.4, and 15.6% of subjects were at normal nutritional status, mild, and moderate-to-severe malnutrition, respectively. After adjusting for potential confounders, participants under mild and moderate-to-severe malnutrition status have a lower MMSE score [β (95% CI): –0.95 (–1.60, –0.25) and –1.39 (–2.21, –0.57), respectively], compared with those having normal nutrition. Also, there was a linear trend in the association of malnutrition risk with cognitive function in the total population [β (95% CI): –0.74 (–1.13, –0.35)]. However, a significant association of malnutrition with cognitive function was observed only among illiterate females aged above 90 years.

Conclusion: This study suggested that there was a significant relationship between the GNRI and cognitive function in the Chinese elderly. Furthermore, subjects with more serious malnutrition have a worse cognitive function, especially in the oldest illiterate females. Clinicians should put more emphasis on assessing the nutritional and cognitive status of the elderly to timely intervene and prevent cognitive impairment.

In-hospital mortality and its predictors among stroke patients in sub-Saharan Africa: A systemic review and meta-analysis

Objective

To assess the in-hospital mortality from acute stroke and its predictors in sub-Saharan Africa.

Method

The literature search was conducted in the databases of PubMed/Medline, Embase, CINAHL, and Google Scholar. The retrieved studies were screened by titles and abstracts, and then full texts were assessed for eligibility. The methodological quality of the included studies was assessed using the Joanna Briggs Institute's critical appraisal checklist. The publication bias was assessed using the funnel plot asymmetry and the Egger tests. Data were analyzed using Stata software version 15.0 in a random-effect model.

Result

A total of 27 studies with a total sample size of 6331 were included in this systematic review and meta-analysis. The pooled estimated prevalence of in-hospital mortality due to stroke was 22% (95% confidence interval = 0.17-0.27). Stroke mortality in Western Africa (37%, 95% confidence interval = 0.24-0.50) was higher than in Eastern Africa (15%, 95% confidence interval = 0.12-0.19) and Southern Africa (18%, 95% confidence interval = 0.06-0.19). In three studies, mortality was higher in hemorrhagic stroke (25%) than ischemic stroke (14%). Risk factors associated with higher mortality were admission Glasgow Coma Scale, stroke severity, age, sex, presence of hypertension, and declined renal function.

Conclusion

The in-patient mortality of stroke in sub-Saharan Africa was high. Therefore, there is an urgent need for further stroke epidemiology studies in stroke subtypes and the performance of patient-level meta-analysis to understand the risk factors associated with mortality and herald appropriate intervention to curb the high mortality rate in the region.

The Relationship Between Prognostic Nutritional Index and All-Cause Mortality in Critically Ill Patients: A Retrospective Study

Purpose

The effectiveness and prognostic value of the prognostic nutritional index (PNI) in critically ill patients are unknown. Hence, this study aimed to analyze the relationship between the PNI and all-cause mortality in critically ill patients.

Patients and Methods

Patient data were obtained from the Multiparameter Intelligent Monitoring in Intensive Care III database. The relationship between the PNI and in-hospital mortality was analyzed using receiver operating characteristic curve analysis and a logistic regression model. Propensity score matching (PSM) was used to eliminate the bias caused by confounding factors. The Kaplan-Meier curve and Cox regression model were used to test the effect of the PNI on 30-, 90-, 180-, and 365-day mortality.

Results

A low PNI score is an independent risk factor for in-hospital mortality in critically ill patients. A total of 3644 cases were successfully matched using PSM. The PSM group with balanced covariates obtained similar results in the three models, which were statistically significant. The Kaplan-Meier curve and Cox regression model showed that the PNI was negatively correlated with 30-, 90-, 180-, and 365-day all-cause mortality.

Conclusion

The PNI score is an independent risk factor for all-cause mortality in critically ill patients, where a low PNI score is associated with increased mortality.

Frequency of Hypoalbuminemia and In-Hospital Mortality in Acute Ischemic Stroke Patients Presenting at a Tertiary Care Hospital, Hyderabad

Background The aim of this study was to determine the frequency of hypoalbuminemia and in-hospital mortality in acute ischemic stroke patients at a tertiary care hospital in Hyderabad. Methodology This was a prospective observational study conducted at the Department of Medicine, Isra University Hospital, Hyderabad, from February 17, 2017 to August 18, 2017. A total of 196 consecutive cases of acute ischemic stroke were included. Hypoalbuminemia was defined as serum albumin of <3.5 mg/dL. In-hospital outcome in terms of survival or death within seven days of admission was assessed and recorded. Data were analyzed using SPSS, version 20.0. (IBM Corp., Armonk, NY, US). Chi-square test was applied, and p-value of ≤0.05 was considered significant. Results Out of the 196 acute ischemic stroke cases, 146 (74.5%) were males and 50 (25.5%) were females. The mean age was 49.31 ± 10.46 years. A total of 90 (45.9%) cases had hypoalbuminemia. Out of these 196 cases, 22 (11.2%) expired within seven days of presentation of acute ischemic stroke, and out of these 22 expired cases, 18 (81.8%) had hypoalbuminemia. In-hospital mortality was found to be strongly associated with hypoalbuminemia (p < 0.001). Conclusions Frequency of hypoalbuminemia was significantly higher in ischemic stroke patients and was found to be associated with in-hospital mortality, warranting monitoring at regular intervals, as well as recognizing and treating it early for risk stratification.

A Novel INCNS Score for Prediction of Mortality and Functional Outcome of Comatose Patients

Objectives: The purpose of this study was to verify the veracity and reliability of the INCNS score for prediction of neurological ICU (NICU) mortality and 3-month functional outcome and mortality in comatose patients.

Methods: In this prospective study, data of the patients admitted to NICU from January 2013 to January 2019 were collected for validation. The 3-month functional outcomes were evaluated using modified Rankin Scale (mRS). By using the receiver operating characteristics curve (ROC) analysis, we compared the INCNS score with Glasgow Coma Scale (GCS), Full Outline of Un-Responsiveness Score (FOUR) and Acute Physiology and Chronic Health Evaluation II (APACHE II) for assessment of the predictive performance of these scales for 3-month functional outcome and mortality and NICU mortality performed at 24- and 72-h after admission to the NICU.

Results: Totally 271 patients were used for evaluation; the INCNS score achieved an AUC (area under the receiver operating characteristic curve) of 0.766 (95% CI: 0.711–0.815) and 0.824 (95% CI: 0.774–0.868) for unfavorable functional outcomes, an AUC of 0.848 (95% CI: 0.800–0.889) and 0.892 (95% CI: 0.848–0.926) for NICU mortality, and an AUC of 0.811 (95% CI: 0.760–0.856) and 0.832 (95% CI: 0.782–0.874) for the 3-month mortality after discharge from the NICU at 24- and 72-h. The INCNS score exhibited a significantly better predictive performance of mortality and 3-month functional outcomes than FOUR and GCS. There was no significant difference in predicting NICU mortality and 3-month functional outcomes between INCNS and APACHE II, but INCNS had better predictive performance of 3-month mortality than APACHE II.

Conclusions: The INCNS score could be used for predicting the functional outcomes and mortality rate of comatose patients.

Development and validation of a new score for predicting functional outcome of neurocritically ill patients: The INCNS score

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.

Analysis of the risk factors for the short-term prognosis of acute ischemic stroke

This study investigated the risk factors for the short-term prognosis of acute ischemic stroke to provide a scientific evidence for improving prevention and treatment. A total of 2557 cases of acute ischemic stroke were included in the study. We collected the data on demographic characteristics, life style-related risk factors, clinical feature, and other clinical characteristics for all the participants. The outcomes were assessed using the modified Rankin scale (mRs) on day 14 or at discharge. According to the mRs score, the subjects were divided into three groups, namely, the control group (0≤ mRs ≤2), the disability group (3≤ mRs ≤5), and the death group (mRs = 6). The general conditions of these three groups were compared. An mRs score of 3≤ mRs ≤6 belonged to the composite outcome group. Logistic regression was also applied to analyze the risk factors of short-term prognosis. Monovariant logistic regression showed that age, on-set admission, hospital stays, temperature, heart rate, stroke subtype, hypertension, hyperglycemia, history of heart disease, history of atrial fibrillation, history of cerebral stroke, drinking, count of WBC, count of mononuclear leucocyte, and rate of neutrophile granulocyte were statically significant. To further control the confounding factors, multivariant logistic regression analysis was carried out. The result showed that age, on-set admission, hospital stays, temperature, heart rate, hyperglycemia, history of atrial fibrillation, and cerebral stroke history were related to the short-term prognosis. Age, on-set admission, hospital stays, temperature, heart rate, hyperglycemia, history of atrial fibrillation, and cerebral stroke history were the risk factors of the short-term prognosis of acute ischemic stroke.

Hypoalbuminemia in critically sick children

CONTEXT

There is a paucity of data evaluating serum albumin levels and outcome of critically ill-children admitted to intensive care unit (ICU).

AIMS

The aim was to study frequency of hypoalbuminemia and examine association between hypoalbuminemia and outcome in critically ill-children.

SETTINGS AND DESIGN

Retrospective review of medical records of 435 patients admitted to 12 bedded pediatric ICU (PICU).

MATERIALS AND METHODS

Patients with hypoalbuminemia on admission or any time during PICU stay were compared with normoalbuminemic patients for demographic and clinical profile. Effect of albumin infusion was also examined. Odds ratio and 95% confidence interval were calculated using SPSS 16.

RESULTS

Hypoalbuminemia was present on admission in 21% (92 of 435) patients that increased to 34% at the end of 1(st) week and to 37% (164 of 435) during rest of the stay in PICU. Hypoalbuminemic patients had higher Pediatric Risk of Mortality scores (12.9 vs. 7.5, P < 0.001) and prolonged PICU stay (13.8 vs. 6.7 days, P < 0.001); higher likelihood of respiratory failure requiring mechanical ventilaton (84.8% vs. 28.8%, P < 0.001), prolonged ventilatory support, progression to multiorgan dysfunction syndrome (87.8% vs. 16.2%) and risk of mortality (25.6% vs. 17.7%). Though, the survivors among recipients of albumin infusion had significantly higher increase in serum albumin level (0.76 g/dL, standard deviation [SD] 0.54) compared with nonsurvivors (0.46 g/dL, SD 0.44; P = 0.016), albumin infusion did not reduce the risk of mortality.

CONCLUSIONS

Hypoalbuminemia is a significant indicator of mortality and morbidity in critically sick children. More studies are needed to define role of albumin infusion in treatment of such patients.