Influence of nutritional status on clinical outcome after acute stroke

A cause-and-effect relation between protein-energy malnutrition and poor outcome in acute stroke patients has not been definitively established. To measure the effect of the nutritional status of hospitalized stroke patients on clinical outcome, a prospective, observational study was performed. Acute stroke patients admitted to Leicester General Hospital from June 1994 to October 1995 had their nutritional status assessed with anthropometric, hematologic, and biochemical methods within 48 h of admission and after 2 and 4 wk. Outcome measures including disability, handicap, length of stay, morbidity (infective complications), discharge destination, and mortality were recorded during the hospital stay and at 3 mo. Nutritional status deteriorated significantly during the study period, but only serum albumin concentrations showed a significant association with various outcome measures. Stroke patients with hypoalbuminemia had a greater risk of infective complications (P<0.0001) and poor functional outcome during hospitalization than those with normal or higher serum albumin concentrations. Serum albumin concentrations were good predictors of the degree of disability and handicap during the hospital stay. After prognostic indicators of poor outcome were adjusted for, serum albumin concentration in the hospital was a strong and independent predictor of mortality at 3 mo after acute stroke [hazard ratio 0.91 (95% CI: 0.84, 0.99) for a 1-g/L higher serum albumin concentration]. Whether nutritional supplementation removes or mitigates the hazard of poor outcome associated with undernutrition after acute stroke needs to be determined.