Prognostic importance of multiple objective nutrition screening indexes in acute ischemic stroke patients treated with intravenous tissue plasminogen activator: A retrospective observational study

IF 2.6 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-08-05 DOI:10.1016/j.clnesp.2025.07.1133

Ezgi Yilmaz, Isa Furkan Sarier, Ethem Murat Arsava, Mehmet Akif Topcuoglu

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引用次数: 0

Abstract

Background

The role of objective nutritional screening indexes in guiding treatment decisions and predicting prognosis in hyperacute stroke remains to be elucidated.

Methods

The modifying effects of nine biochemical parameters (albumin, globulin, blood urea nitrogen [BUN], creatinine, total lymphocyte count, AST, ALT, total cholesterol, triglycerides), three derived ratios (albumin-to-globulin, AST-to-ALT, BUN-to-creatinine), and seven objective nutritional indexes—namely CONUT (Controlling Nutritional Status score), PNI (Prognostic Nutritional Index), GNRI (Geriatric Nutritional Risk Index), INA (Instant Nutritional Assessment), AGS (Albumin-Globulin Score), TCBI (Triglyceride-Total Cholesterol-Body Weight Index), and CPNI (Cholesterol-modified Prognostic Nutritional Index)—were evaluated with respect to clinical outcomes in a cohort of 299 patients with acute ischemic stroke who received intravenous tissue plasminogen activator (IV-tPA). Discriminative efficacy was considered clinically meaningful when the lower bound of the receiver operating characteristic (ROC) area under the curve (AUC) reached or exceeded 0.6 at the 95 % confidence interval.

Results

Independent risk predictors for mortality were admission creatinine (OR = 2.479), globulin (OR = 2.203), CONUT score (OR = 1.362), CONUT high score group (OR = 4.332), PNI score (OR = 0.879), PNI high risk category (OR = 8.151), GNRI score (OR = 0.957) and GNRI moderate to severe category (OR = 4.559) according to regression analysis. Albumin (OR = 0.262) and albumin/globulin ratio (OR = 0.086) were found to be independent predictors of survival. However, only albumin (>3.8 g/dL) (AUC = 0.666) and albumin/globulin ratio (>1.33) (AUC = 0.601) provided a satisfactory discrimination capacity. ROC and PRC analyses documented that none of the other parameters reached clinically adequate discrimination capacity in terms of 3-months excellent or good outcome, symptomatic tPA-related brain hemorrhage, positive and dramatic response to tPA.

Conclusions

Objective Nutritional Screening Indices do not provide adequate guidance in determining prognosis in acute ischemic stroke patients receiving IV tPA.

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多种客观营养筛查指标对静脉注射组织型纤溶酶原激活剂治疗急性缺血性脑卒中患者预后的重要性：一项回顾性观察研究。

背景：客观营养筛查指标在超急性脑卒中中指导治疗决策和预测预后中的作用尚待阐明。方法:9项生化指标（白蛋白、球蛋白、血尿素氮（BUN）、肌酐、总淋巴细胞计数、AST、ALT、总胆固醇、甘油三酯）、3项衍生比率（白蛋白/球蛋白、AST / ALT、BUN /肌酐）和7项客观营养指标(CONUT（控制营养状态评分）、PNI（预后营养指数）、GNRI（老年营养风险指数）、INA（即时营养评估）、AGS（白蛋白-球蛋白评分）、对299例接受静脉组织型纤溶酶原激活剂（IV-tPA）治疗的急性缺血性卒中患者的临床结果进行了TCBI（甘油三酯-总胆固醇-体重指数）和CPNI（胆固醇修饰预后营养指数）的评估。当受试者工作特征（ROC）曲线下面积（AUC）的下界在95%置信区间达到或超过0.6时，认为判别疗效具有临床意义。结果：根据回归分析，死亡率的独立危险预测因子为入院肌酐（OR=2.479）、球蛋白（OR=2.203）、CONUT评分（OR=1.362）、CONUT高分组（OR=4.332）、PNI评分（OR=0.879）、PNI高危组（OR=8.151）、GNRI评分（OR=0.957）、GNRI中重度组（OR=4.559）。白蛋白（OR=0.262）和白蛋白/球蛋白比（OR=0.086）是生存的独立预测因子。然而，只有白蛋白（>3.8 g/dL）（AUC=0.666）和白蛋白/球蛋白比（>1.33）（AUC=0.601）提供了令人满意的鉴别能力。ROC和PRC分析表明，在3个月的优异或良好预后、tPA相关症状性脑出血、tPA阳性和显著反应方面，其他参数均未达到临床足够的区分能力。结论：目的营养筛查指标不能充分指导急性缺血性脑卒中患者静脉注射tPA后的预后。

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.