Association between nutritional status and mortality/neurological outcomes in stroke patients: A systematic review and meta-analysis

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-07-15 DOI:10.1016/j.jstrokecerebrovasdis.2025.108398

Jihui Hu , Yang Liu , Yi Zhang, Meng Zhang, Li Zhang

{"title":"Association between nutritional status and mortality/neurological outcomes in stroke patients: A systematic review and meta-analysis","authors":"Jihui Hu , Yang Liu , Yi Zhang, Meng Zhang, Li Zhang","doi":"10.1016/j.jstrokecerebrovasdis.2025.108398","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>To systematically evaluate the association between Nutritional Risk Screening 2002 (NRS-2002), Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index (GNRI), and 3-month mortality and poor neurological outcomes (modified Rankin Scale [mRS] ≥3) in stroke patients.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, Embase, and other databases up to April 2025 identified 11 observational studies (6 prospective cohorts; <em>n</em> = 7696). Study quality was assessed using the Newcastle-Ottawa Scale. Random-effects models were used to calculate pooled odds ratios (ORs) with 95 % confidence intervals (CIs). Heterogeneity, sensitivity, and publication bias were assessed. Meta-regression explored sources of heterogeneity. A gradient boosting classifier and Bayesian MCMC simulations were used for supplementary modeling.</div></div><div><h3>Results</h3><div>NRS-2002 ≥ 3 (OR=3.42, 95 % CI: 2.59–4.51), CONUT ≥5 (OR=3.66, 95 % CI: 2.47–5.43), and GNRI <98 (OR=2.68, 95 % CI: 1.86–3.84) were significantly associated with poor functional outcomes. These indices also predicted higher 3-month mortality: NRS-2002 ≥ 3 (OR=4.13), CONUT ≥5 (OR=3.57), GNRI <98 (OR=2.93). Heterogeneity ranged from moderate to high (I²=42.1–68.9 %). Meta-regression implicated regional and clinical factors as sources of variability. Predictive modeling (AUROC = 0.81) identified GNRI <92, age ≥75, and NIHSS as key mortality predictors, consistent with SHAP and Bayesian analyses.</div></div><div><h3>Conclusion</h3><div>Malnutrition—particularly as defined by NRS-2002 ≥ 3, CONUT ≥5, and GNRI <98—is strongly linked to early mortality and poor recovery after stroke. GNRI showed high predictive value in older patients. Integrating nutritional screening into acute stroke care may enable early, cost-effective interventions to improve outcomes.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 9","pages":"Article 108398"},"PeriodicalIF":1.8000,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Stroke & Cerebrovascular Diseases","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1052305725001764","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"NEUROSCIENCES","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

To systematically evaluate the association between Nutritional Risk Screening 2002 (NRS-2002), Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index (GNRI), and 3-month mortality and poor neurological outcomes (modified Rankin Scale [mRS] ≥3) in stroke patients.

Methods

A systematic search of PubMed, Embase, and other databases up to April 2025 identified 11 observational studies (6 prospective cohorts; n = 7696). Study quality was assessed using the Newcastle-Ottawa Scale. Random-effects models were used to calculate pooled odds ratios (ORs) with 95 % confidence intervals (CIs). Heterogeneity, sensitivity, and publication bias were assessed. Meta-regression explored sources of heterogeneity. A gradient boosting classifier and Bayesian MCMC simulations were used for supplementary modeling.

Results

NRS-2002 ≥ 3 (OR=3.42, 95 % CI: 2.59–4.51), CONUT ≥5 (OR=3.66, 95 % CI: 2.47–5.43), and GNRI <98 (OR=2.68, 95 % CI: 1.86–3.84) were significantly associated with poor functional outcomes. These indices also predicted higher 3-month mortality: NRS-2002 ≥ 3 (OR=4.13), CONUT ≥5 (OR=3.57), GNRI <98 (OR=2.93). Heterogeneity ranged from moderate to high (I²=42.1–68.9 %). Meta-regression implicated regional and clinical factors as sources of variability. Predictive modeling (AUROC = 0.81) identified GNRI <92, age ≥75, and NIHSS as key mortality predictors, consistent with SHAP and Bayesian analyses.

Conclusion

Malnutrition—particularly as defined by NRS-2002 ≥ 3, CONUT ≥5, and GNRI <98—is strongly linked to early mortality and poor recovery after stroke. GNRI showed high predictive value in older patients. Integrating nutritional screening into acute stroke care may enable early, cost-effective interventions to improve outcomes.

查看原文本刊更多论文

脑卒中患者营养状况与死亡率/神经预后之间的关系：一项系统综述和荟萃分析。

目的：系统评价2002年营养风险筛查（NRS-2002）、控制营养状况（CONUT）评分、老年营养风险指数（GNRI）与脑卒中患者3个月死亡率和不良神经预后（改良Rankin量表[mRS]≥3）之间的关系。方法：系统检索PubMed， Embase和其他数据库，截至2025年4月，确定了11项观察性研究(6个前瞻性队列；n = 7696)。使用纽卡斯尔-渥太华量表评估研究质量。随机效应模型用于计算95%置信区间（ci）的合并优势比（ORs）。评估异质性、敏感性和发表偏倚。元回归分析了异质性的来源。使用梯度增强分类器和贝叶斯MCMC模拟进行补充建模。结果：NRS-2002≥3 (OR=3.42, 95% CI: 2.59-4.51), CONUT≥5 (OR=3.66, 95% CI: 2.47-5.43)， GNRI结论：营养不良-特别是NRS-2002≥3，CONUT≥5和GNRI定义的营养不良

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.