Study On The Association And Predictive Value Of Nutritional Status With Long-Term Prognosis In Patients With Acute Ischemic Stroke

Research background:Malnutrition is a well-known risk factor for poor outcomes in patients with cancer and cardiovascular disease,but there is limited epidemiological evidence on the association between malnutrition and poor prognosis and long-term risk of all-cause mortality in patients with acute ischemic stroke(AIS).Objective:This study was based on a multicenter cohort to assess the nutritional status of patients with AIS at admission,to analyze the relationship between nutritional level and long-term prognosis and all-cause mortality,and to evaluate its value in predicting poor prognosis and death.Methods:A total of 2628 patients admitted with AIS were recruited from 12 hospitals in Jiangxi province,and Controlling Nutritional Status(CONUT)score,Geriatric Nutritional Risk Index(GNRI),Prognostic Nutritional Index(PNI)and TCBI were calculated at baseline.Prognostic Nutritional Index(PNI)and TCBI(TG×TC×BW Index),and multifactorial logistic regression was used to determine significant predictors of prognosis at 1 year of follow-up,and Kaplan-Meier analysis and Cox regression were used to assess the correlation between nutritional status and all-cause mortality in patients with AIS.The relationship between nutritional scores and poor prognosis and all-cause mortality was further explored using the restricted cubic spline method.In addition,the area under the curve was used to assess which nutritional scores had the greatest predictive value for long-term poor prognosis and all-cause mortality in the general population.Results:At the 1-year follow-up,a total of 290(15.2%)patients had a poor prognosis(m RS ≥3 points),of whom 54(2.8%)died from all causes.According to CONUT,GNRI and PNI scores,363(19.125%),221(11.644%)and 54(2.845%)patients were at risk of moderate to severe malnutrition,respectively.After adjusting for long-term poor prognosis for confounding factors,moderate to severe malnutrition was found to remain significantly associated with long-term poor prognosis(GNRI,OR=1.677,95% CI: 1.146-2.453;PNI,OR=2.312,95% CI: 1.254-4.261),which can increase the risk of long-term poor prognosis in patients with AIS;for all-cause mortality Different levels of nutritional status assessed using GNRI were associated with an increased risk of all-cause mortality(p<0.001;HR=8.6;95% CI: 3.710-19.935).In the study population,there was a linear relationship between the risk of long-term poor prognosis and all-cause mortality and the four nutrition scores.In addition,the PNI score was a better predictor of long-term adverse prognosis in patients with AIS compared with other nutritional scores(AUC=0.64),but its predictive efficacy was lower than the traditional THRIVE(Totaled Health Risks in Vascular Events)score(AUC=0.69);for AIS patients,GNRI had the best all-cause mortality prediction in the AIS population(AUC=0.77)and PNI curve(AUC=0.74)with higher AUC values and higher mortality prediction accuracy than the traditional THRIVE score.Conclusion:This study found that patients who were malnourished at admission had a higher risk of poor prognosis and all-cause mortality.A linear relationship was found between nutrition scores and poor prognosis and all-cause mortality in the general population,and CONUT,GNRI,PNI and TCBI could be useful predictors of long-term prognosis and all-cause mortality in patients with AIS,so that early nutritional management and necessary nutritional interventions to promote improved prognosis in patients with AIS could be implemented.