Protein-energy malnutrition prevalence and influence on complications and outcome of severe stroke, requiring mechanical ventilation: a multicenter prospective observational trial

Abstract

INTRODUCTION: Stroke is characterized by high prevalence and mortality. Protein-energy deficiency is a common syndrome in this category of patients, affecting the course and outcomes of cerebral stroke. OBJECTIVE: The purpose of the study was to analyze the prevalence and impact on the course and outcome of stroke of protein-energy deficiency in patients with mechanical ventilation. MATERIALS AND METHODS: A multicenter observational clinical study “Register of respiratory therapy in patients with stroke (RETAS)” was conducted under the auspices of the Russian Federation of Anesthesiologists and Reanimatologists. The study involved 14 centers, included 1289 acute stroke patients received respiratory support. RESULTS: Protein-energy deficiency in patients with stroke on mechanical ventilation was associated with a tendency to a greater risk of a lethal outcome (p = 0.0003). The absence of protein-energy malnutrition in patients with stroke severity less than 14 points during mechanical ventilation was associated with a greater likelihood of a positive outcome (Glasgow Outcome Scale, GOS 4 and 5) compared with patients with signs of malnutrition (p = 0.000002). Protein-energy malnutrition is associated with prolonged stay in ICU of patients with stroke on mechanical ventilation (p < 0.0001). At the same time, the group of patients with prolonged mechanical ventilation was characterized by a high prevalence of bedsores (p < 0.0001), hypoproteinemia, hypoalbuminemia (р = 0.0001), and decreased body weight 10 percent or more (p < 0.0001). The presence of protein-energy malnutrition was accompanied by an increased risk of ventilator-associated tracheobronchitis in patients with stroke (p < 0.0001). CONCLUSIONS: Protein-energy malnutrition significantly influences on the course and clinical outcome parameters of severe cerebral stroke patients on mechanical ventilation.