脳卒中での病前の栄養状態と短期予後

脳卒中における病前の栄養状態と短期予後を見たインドの論文を紹介します。

Pandian JD, Jyotsna R, Singh R, Sylaja PN, Vijaya P, Padma MV, Venkateswaralu K, Sukumaran S, Radhakrishnan K, Sarma PS, Mathew R, Singh Y. Premorbid nutrition and short term outcome of stroke: a multicentre study from India. J Neurol Neurosurg Psychiatry. 2011 Oct;82(10):1087-92.

病前の栄養状態は脳卒中発症後48時間以内にSGA（主観的包括的評価）を行い、栄養状態良好か栄養不良（中等度と重度を含む）に分類しました。脳卒中の機能予後は発症30日後のmodified Rankin scaleで評価して、3より高い場合を予後不良としました。

modified Rankin scaleは下記のHPを参照してください。
http://www.jsts.gr.jp/guideline/350_351.pdf

結果ですが、病前にSGAで低栄養と判定された患者は27.2％でした。病前の低栄養は多変量解析で独立した予後に影響を与える因子でした。低栄養の脳卒中患者では予後が悪いというエビデンスはすでにありますが、今回も同様の結果でした。このくらいの臨床研究なら日本でも十分できるのに…と感じたのは私だけでしょうか。

Abstract
BACKGROUND: Little is known about the impact of premorbid undernutrition on stroke outcome in developing countries. AIM: To study the impact of premorbid undernutrition status, measured by the Subjective Global Assessment (SGA) tool, on short term stroke outcome.

METHODS: First ever stroke patients admitted to six major hospitals in North and South India participated in this study from 1 March 2008 to 30 September 2009. The SGA tool was administered within 48 h of stroke onset, and 6 months premorbid nutritional status was rated as well nourished (A rating) and undernourished (B and C ratings) using this tool. Stroke outcome was assessed after 30 days using the modified Rankin scale (mRs), and a mRs score > 3 was defined as a poor outcome. Statistical analyses were performed using SPSS Statistics V.17.0.

RESULTS: Of 477 patients enrolled, 448 patients were included in the analyses. Mean age was 58.1±13.7&emsp14;years (range 16-96) and 281 (62.7%) patients were men. At admission, premorbid undernutrition was found in 121 (27.2%) patients. Older age (OR 4.99, CI 1.26 to 19.64, p=0.021), hypertension (OR 1.99, CI 1.04 to 3.79, p=0.037) and patients from Andhra Pradesh State (OR 1.87, CI 1.05 to 3.32, p=0.032) were predictors of undernutrition in multiple logistic regression analysis. Premorbid undernutrition (OR 1.99, CI 1.20 to 3.31, p=0.007) and length of hospital stay (OR 3.41, CI 1.91 to 6.06, p<0.0001) were the independent predictors of poor outcome in the multiple logistic regression model.

CONCLUSIONS: High rates of premorbid undernutrition in stroke patients were found. Age, hypertension and patients from Andhra Pradesh State were predictors of premorbid undernutrition. Premorbid undernutrition was associated with poor stroke outcome. The results provide opportunities for primary prevention and improving stroke outcome.