OBJECTIVE To investigate the incremental prognostic significance of malnutrition in patients with severe post-stroke disability. DESIGN Retrospective cohort study. The patients were recruited from three specialized inpatient rehabilitation facilities. Nutritional status was assessed using the Prognostic Nutritional Index (PNI) that is calculated from serum albumin and total lymphocyte count. Scores >38 points reflect normal nutritional status, scores of 35-to-38 moderate malnutrition, scores <35 severe malnutrition. The association of PNI categories with outcomes was assessed using multivariable regression analyses. SETTING inpatient rehabilitation facility. PARTICIPANTS Six hundred sixty-eight patients with ischemic stroke admitted to inpatient rehabilitation within 90 days from stroke occurrence and classified as Case-Mix Groups 0108, 0109, and 0110 of the current Medicare case-mix classification system. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Three outcomes were examined: 1) the combined outcome of transfer to acute care and death within 90 days from admission to rehabilitation; 2) two-year mortality; 3) Functional Independence Measure (FIM)-motor effectiveness, calculated as (FIM-motor change/maximum FIM-motor minus admission FIM-motor score)x100. RESULTS Overall, the median time to rehabilitation admission was 18 (12-26) days. The prevalence of moderate and severe malnutrition was 12.7% and 11.5%, respectively. Ninety-one (13.6%) patients experienced the combined outcome. After adjusting for independent predictors including sex, atrial fibrillation, dysphagia, FIM cognitive score, and haemoglobin levels, neither moderate (p=.280) nor severe malnutrition (p=.482), were associated with the combined outcome. Similar results were observed when looking at 2-year mortality. Overall, FIM-motor effectiveness was 30±24%. After adjusting for independent predictors, severe malnutrition (β coefficient -0.458±0.216;p=.034) was associated with FIM-motor effectiveness. CONCLUSIONS Approximately 1 in every 9 patients presented severe malnutrition. On top of the independent predictors, severe malnutrition did not provide additional prognostic information concerning risk of the combined outcome or 2-year mortality. Conversely, severe malnutrition was associated with poorer functional outcome as expressed by FIM-motor effectiveness.

中文翻译：

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接受康复治疗的严重缺血性卒中患者营养不良与结局之间的关系。

目的 研究营养不良对严重卒中后残疾患者预后的增量意义。设计 回顾性队列研究。患者是从三个专门的住院康复机构招募的。使用预后营养指数 (PNI) 评估营养状况，该指数由血清白蛋白和总淋巴细胞计数计算。得分>38 分反映营养状况正常，得分为 35-38 中度营养不良，得分 <35 为重度营养不良。使用多变量回归分析评估 PNI 类别与结果的关联。设置住院康复设施。参与者 668 名缺血性中风患者在中风发生后 90 天内接受住院康复治疗，并归类为病例混合组 0108、0109、和 0110 当前医疗保险病例组合分类系统。干预 不适用。主要结局指标 研究了三个结局：1）从入院到康复的 90 天内转入急症治疗和死亡的综合结局；2) 两年死亡率；3) 功能独立性测量 (FIM)-运动效果，计算为（FIM-运动变化/最大 FIM-运动减去入场 FIM-运动得分）x100。结果 总体而言，康复入院的中位时间为 18 (12-26) 天。中度和重度营养不良的患病率分别为 12.7% 和 11.5%。91 名 (13.6%) 患者经历了综合结果。在调整包括性别、心房颤动、吞咽困难、FIM 认知评分和血红蛋白水平在内的独立预测因素后，既不是中度 (p=.280) 也不是重度营养不良 (p=.482)，与综合结果相关。在观察 2 年死亡率时观察到类似的结果。总体而言，FIM 运动有效性为 30±24%。调整独立预测因素后，严重营养不良（β 系数 -0.458±0.216；p=.034）与 FIM 运动有效性相关。结论 每 9 名患者中约有 1 名出现严重营养不良。除了独立预测因素之外，严重营养不良并没有提供关于联合结局风险或 2 年死亡率的额外预后信息。相反，如 FIM 运动有效性所表达的，严重营养不良与较差的功能结果相关。严重营养不良（β 系数 -0.458±0.216；p=.034）与 FIM 运动有效性相关。结论 每 9 名患者中约有 1 名出现严重营养不良。除了独立预测因素之外，严重营养不良并没有提供关于联合结局风险或 2 年死亡率的额外预后信息。相反，如 FIM 运动有效性所表达的，严重营养不良与较差的功能结果相关。严重营养不良（β 系数 -0.458±0.216；p=.034）与 FIM 运动有效性相关。结论 每 9 名患者中约有 1 名出现严重营养不良。除了独立预测因素之外，严重营养不良并没有提供关于联合结局风险或 2 年死亡率的额外预后信息。相反，如 FIM 运动有效性所表达的，严重营养不良与较差的功能结果相关。