低栄養脳卒中患者は機能予後不良

急性期脳卒中患者において低栄養が長期機能予後に与える影響をみた台湾の観察研究を紹介します。

Shen HC, Chen HF, Peng LN, Lin MH, Chen LK, Liang CK, Lo YK, Hwang SJ. Impact of nutritional status on long-term functional outcomes of post-acute stroke patients in Taiwan. Arch Gerontol Geriatr. 2011 Sep-Oct;53(2):e149-52.

483人の初回脳卒中患者のうち、95人（19.7%）が低栄養で、310人が6ヶ月後に生存し、244人が機能予後が良好でした。多変量解析で機能予後不良に関連する独立した因子は、高齢、入院時のNIHSS得点、低栄養でした。以上より脳卒中では急性期  より低栄養に配慮すべきとしています。

急性期脳卒中で低栄養の場合に機能予後が悪いことはFOOD Trialで検証されていますが、今回も同様の結果です。脳卒中が重症で侵襲が高度の場合に低栄養になりやすく、このような患者で予後が悪い可能性もありますが、急性期から栄養管理が重要であることは確かだと考えます。

Abstract
Nutritional status is important in stroke care, but little is known regarding to the prognostic role of nutritional status on long-term functional outcomes among stroke survivors. The main purpose of this study was to evaluate to the prognostic role of nutritional status on long-term functional outcomes among stroke survivors. Data of acute stroke registry in Kaohsiung Veterans General Hospital were retrieved for analysis. Overall, 483 patients (mean age = 70.7 ± 10.3 years) with first-ever stroke were found. Among them, 95 patients (19.7%) were malnourished at admission, 310 (mean age = 70.4 ± 10.1 years, 63.5% males) survived for 6 months, and 244 (78.7%) had good functional outcomes. Subjects with poor functional outcomes were older (74.7 ± 8.9 vs. 69.0 ± 10.1 years, p < 0.001), more likely to be malnourished (56.2% vs. 26.6%, p < 0.001), to develop pneumonia upon admission (23.3% vs. 12.7%, p = 0.027), had a longer hospital stay (23.5 ± 13.9 vs. 12.5 ± 8.2 days, p < 0.001), had a higher National Institutes of Health Stroke Scale (NIHSS) score (12.9 ± 9.3 vs. 4.9 ± 4.3, p < 0.001), poorer stroke recovery (NIHSS improvement: 6.9% vs. 27.4%, p = 0.005), and poorer functional improvement (Barthel index = BI improvement in the first month: 31.4% vs. 138%, p < 0.001). Older age (odds ratio = OR) = 1.07, 95% confidence interval (CI = 1.03-1.11, p<0.001), baseline NIHSS score (OR = 1.23, 95%CI = 1.15-1.31, p < 0.001) and malnutrition at acute stroke (OR = 2.57, 95%CI: 1.29-5.13, p<0.001) were all independent risk factors for poorer functional outcomes. In conclusion, as a potentially modifiable factor, more attentions should be paid to malnutrition to promote quality of stroke care since the acute stage.