Malnutrition Increases the Incidence of Death, Cardiovascular Events, and Infections in Patients with Stroke after Rehabilitation

Background: Although the impact of malnutrition in patients with acute stroke has been reported, its significance after rehabilitation is not well understood. The geriatric nutritional risk index (GNRI) is a simple and well-established nutritional screening tool that predicts poor prognosis in elderly patients and in those with a high risk of cardiovascular events. We investigated the associations between GNRI and all-cause mortality, cardiovascular events, and infectious diseases in patients with stroke after rehabilitation. Methods: This study included 138 patients aged 80 years or below who were discharged between 2010 and 2013 in a single center, and followed up for more than 1 year. Malnutrition was defined as a GNRI of 96 or lower. Results: The mean age was 63.9 +/- 11.0 years, the mean GNRI at discharge was 98.8 +/- 6.5, and the mean total functional independence measure (FIM) score at discharge was 91.8 +/- 25.8. Among the patients, 37 (27%) had malnutrition. During the follow-up period, all-cause mortality, cardiovascular events, and infectious diseases were recorded in 11 (8%), 21 (15%), and 20 (15%) patients, respectively. Kaplan-Meier curves showed a significantly higher incidence of each outcome in patients with a GNRI of 96 or lower. In the Cox proportional analysis, GNRI was an independent determinant of all-cause mortality (hazard ratio [HR],.71; 95% confidence interval [CI],.61-. 83), cardiovascular events (HR,.87; 95% CI,.80-.95), and infectious diseases (HR,.80; 95% CI,.74-.87) after adjusting for age, gender, and total FIM score. Conclusions: Malnutrition has a negative impact on prognosis in patients with stroke even after rehabilitation.