Association between the malnutrition universal screening tool and stroke-associated infection in acute ischemic...

Malnutrition is associated with adverse outcomes in patients with acute ischemic stroke, including increased risk of infections. The Malnutrition Universal Screening Tool (MUST) is widely used for nutritional risk assessment in patients with stroke. However, the association between the MUST score and stroke-associated infection remains unclear. This study aimed to investigate the association between a high MUST score (≥2) at admission and stroke-associated infection (SAI) in patients with acute ischemic stroke.

We conducted a retrospective cohort study using a prospective stroke registry. Consecutive patients with acute ischemic stroke admitted between 2018 and 2020 were included. MUST score at admission was retrospectively assessed by registered dietitians. The primary outcome was SAI, including hospital-acquired pneumonia (HAP), and the secondary outcome was HAP. Association between high MUST score and outcomes was evaluated using Fine-Gray competing-risk regression models, treating in-hospital death and live discharge as competing events. Exploratory subgroup analysis according to age, sex, stroke severity, and dysphagia state was also performed.

Among 789 patients (median age, 78 years; 56.4% male), 334 (42.3%) had a MUST score ≥2. SAI occurred in 77 patients (9.8%), with HAP accounting for 46 (5.8%) of cases. Patients with a high MUST score had a significantly higher cumulative incidence of both SAI and HAP (Gray's test, both P < 0.001). In multivariable Fine-Gray competing-risk analyses, a high MUST score was associated with an increased risk of SAI (adjusted SHR 5.46, 95% CI 2.75-10.9) and HAP (adjusted SHR 5.63, 95% CI 2.24-14.1). These associations were substantially attenuated after additional adjustment for baseline swallowing status using the Functional Oral Intake Scale. Exploratory subgroup analyses suggested stronger associations among patients with mild stroke (National Institutes of Health Stroke Scale score ≤ 5; p _{for interaction} = 0.045 in SAI and p _{for interaction} = 0.011 in HAP) CONCLUSION: MUST score ≥2 at admission was associated with an increased risk of SAI/HAP in patients with acute ischemic stroke.