Malnutrition Predictive of Poor Outcomes After Stroke Hospitalization

Researchers confirmed that malnutrition is predictive of poor outcomes in patients with cardioembolic stroke and stroke of other etiologies.

Malnutrition, as determined by the Controlling Nutritional Status (CONUT) score, was predictive of poor outcomes in patients with cardioembolic stroke and stroke of other etiologies, according to study results published in the Journal of the Neurological Sciences.

This retrospective study included total of 1915 consecutive patients with ischemic stroke (mean age, 73±12 years) who were hospitalized at 2 different hospitals in China within 7 days of stroke onset. Patients were admitted with either small-vessel occlusion (n=533), large-artery atherosclerosis (n=457), cardioembolic stroke (n=484), or other stroke etiologies (n=441).

The study investigators calculated each patient’s CONUT score using serum albumin levels, lymphocyte counts, and total cholesterol levels. A CONUT score of 5 to 12 was used to define moderate or severe malnutrition. The investigators examined outcomes in patients who were malnourished, with poor outcomes defined by a modified Rankin Scale score of ≥3 at 3 months after stroke hospitalization.

Approximately 79.3% (n=1518) of the cohort was assessed for functional outcomes at 3 months after the onset of stroke. Of these patients, 7.4% (n=113) were considered malnourished based on CONUT scores. In addition, a total of 533 patients (35.1%) had poor outcomes. CONUT scores indicative of malnutrition were more common in patients who had a poor outcome than in those who had a good outcome (13.9% vs 4.1%, respectively; P <.001).

According to an analysis adjusted for age, sex, and baseline stroke severity, malnutrition was an independent predictor of poor outcomes in patients with cardioembolic stroke (odds ratio [OR], 3.25; 95% CI, 1.02-10.4; P =.044) and other stroke etiologies (OR, 6.22; 95% CI, 2.71-14.3; P <.001). In a similar analysis adjusted for potential confounding factors, each of the 3 nutritional indicators used in the study were independently associated with poor outcomes in patients with stroke of other etiologies, including CONUT score ≥5 (OR, 5.12; 95% CI, 1.99-13.2; P <.001), low Geriatric Nutritional Risk Index (OR, 6.44; 95% CI, 2.89-14.4; P <.001), and anemia (OR, 1.95; 95% CI, 1.05-3.63; P =.036).

Limitations of the study included consequences of its retrospective design, the lack of information on patients’ prehospitalization nutrition status, and the inability of the researchers to assess CONUT score at the onset of stroke.

 Additional studies, the investigators concluded, “are needed to clarify whether nutritional intervention improves the stroke functional outcome.”


Naito H, Hosomi N, Nezu T, et al. Prognostic role of the controlling nutritional status score in acute ischemic stroke among stroke subtypes. J Neurol Sci. 2020;416:116984.