Malnutrition and the Risk of Early Neurological Deterioration in Elderly Patients with Acute Ischemic Stroke

BACKGROUND AND PURPOSE: This study aimed to investigate the relationship between malnutrition and early neurological deterioration (END) in elderly patients with acute ischemic stroke in China. METHODS: We used the registry data in the Third Affiliated Hospital of Nantong University and Nanjing Brain Hospital from June 2019 to January 2021. Malnutrition risk was evaluated by controlling nutritional status score (CONUT), geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI) score, respectively. END was defined as an increment of at least two points in the total NIHSS score within three days after admission. We evaluated the relationship between malnutrition and END with multivariable logistic regression models and reclassification indexes. RESULTS: A total of 732 elderly patients with first-ever acute ischemic stroke were included in the study. 243 patients developed END. 5.7%, 21.4%, 4.6% patients were classified as moderate to severe malnutrition by CONUT, GNRI and PNI, respectively. Malnutrition was associated with the risk of END for CONUT (odds ratio [OR], 1.210; 95% confidence interval [CI] 1.092–1.341; P < 0.001), for GNRI (OR, 0.943; 95% CI, 0.919–0.967; P < 0.001), and for PNI (OR, 0.936; 95% CI, 0.908–0.965; P < 0.001) in multivariable logistic regression models using the back-ward selection method. The discriminative ability was 0.763 (95% CI, 0.727–0.798) for CONUT, 0.769 (95% CI, 0.733–0.805) for GNRI and 0.769 (95% CI, 0.733–0.805) for PNI after adjusting for confounders. Besides, adding malnutrition indexes into models made the prediction of END more accurate. CONCLUSION: Malnutrition was associated with END in elderly Chinese patients with acute ischemic stroke.