Factors and predictive model for malnutrition in poststroke disabled patients: A multicenter cross-sectional study

Background

Although malnutrition has been shown to influence the clinical outcome of poststroke disabled patients, the associated factors and the prediction model have yet to be uncovered.

Objectives

This study aims to assess the current prevalence and factors associated with malnutrition in poststroke disabled patients and establish a prediction model.

Methods

A multicenter cross-sectional survey among Chinese poststroke disabled patients (≥18 y old) was conducted in 2021. Information on patients’ basic data, medical history, Barthel Index, dysphagia, and nutritional status was collected. A multivariable logistic regression model was used to identify the factors that influence malnutrition. Nomogram was developed and internal validation was conducted using 5-fold cross-validation. External validation was performed using the data from a preliminary survey. Receiver operating characteristic (ROC) analysis, calibration curves, and decision curve analysis (DCA) were used to analyze the predictive value of the nomogram.

Results

Four hundred fifty-seven cases were enrolled, with the prevalence of malnutrition as 71.77%. Age (aOR = 1.039, 95% CI: 1.006–1.078), pulmonary infection (aOR = 4.301, 95% CI: 2.268–14.464), dysphagia (aOR = 24.605, 95% CI: 4.966–191.058), total intake volume (aOR = 0.997, 95% CI: 0.995–0.999), Barthel Index (aOR = 0.965, 95% CI: 0.951–0.980), and nasogastric tube (aOR = 16.529, 95% CI: 7.418–52.518) as nutrition support mode (compared to oral intake) were identified as the associated factors of malnutrition in stroke-disabled patients (P < 0.05). ROC analysis showed that the area under the curve (AUC) for nomogram was 0.854 (95% CI: 0.816–0.892). Fivefold cross-validation showed the mean AUC as 0.829 (95% CI: 0.784–0.873). There were no significant differences between predicted and actual probabilities. The DCA revealed that the model exhibited a net benefit when the risk threshold was between 0 and 0.4.

Conclusions

Age, pulmonary infection, dysphagia, nutrition support mode, total intake volume, and Barthel Index were factors associated with malnutrition in stroke-related disabled patients. The nomogram based on the result exhibited good accuracy, consistency and values.