Geriatric Nutrition Risk Index Predicts Poor Swallowing Recovery in Acute Ischemic Stroke

Objectives To investigate the association between malnutrition status on admission and short-term swallowing recovery in acute ischemic stroke. Methods We retrospectively analyzed patients with acute ischemic stroke and dysphagia who were admitted to our institute between January 2018 and December 2020. The swallowing function was assessed using the Food Oral Intake Scale (FOIS), and patients with initial FOIS levels of 1-3, which represent tube-dependent nutrition, were enrolled. Poor swallowing recovery was defined as a FOIS score of 1-3 on day 14. The nutritional status at admission was assessed using the Geriatric Nutritional Risk Index (GNRI) and categorized as follows: >98, no nutritional risk; 92-98, mild nutritional risk; 82-92, moderate nutritional risk; and <82, severe nutritional risk. Results Among 189 patients (median age, 85 years; male, 39%), 123 (65%) had poor swallowing recovery. This group had a higher NIHSS score, a lower rate of improvement with reperfusion therapy, a higher rate of aspiration pneumonia, and a lower GNRI. In a multivariate logistic regression analysis, a lower GNRI was independently associated with poor swallowing recovery [per-point decrease; adjusted odds ratio (OR) 1.03, 95% confidence interval (CI) 1.00-1.07]. Furthermore, when "severe" and "moderate" nutritional risk were analyzed as a single class, moderate or severe nutritional risk (GNRI <92) was independently associated with poor swallowing recovery (adjusted OR 2.78, 95% CI 1.14-6.67), relative to no nutritional risk (GNRI >98). Conclusion Lower GNRI at admission was independently associated with poor short-term swallowing recovery in patients with acute ischemic stroke.