EFFECT OF MALNUTRITION AFTER ACUTE STROKE ON CLINICAL OUTCOME

Background and Purpose Malnutrition has received little attention in a cute stroke, although it represents a risk of decreased immunity and n osocomial infections. Our objectives were to determine the prevalence of malnutrition after 1 week of hospitalization in acute stroke and to establish its relation to the stress response and neurological outcom e. Methods The study included 104 patients with an acute stroke of les s than 24 hours' duration. Nutritional parameters (triceps skinfold th ickness, midarm muscle circumference, serum albumin, and calorimetry) were evaluated at admission and after 1 week. Stress response (free ur inary cortisol) was measured daily during the first week. Neurological deficit was evaluated by the Canadian Stroke Scale. Clinical outcome was estimated by the Barthel Index 1 month after the acute stroke. Pat ients received an oral standard diet or polymeric enteral nutrition wh en they had swallowing difficulties. Results Protein-energy malnutriti on was observed in 16.3% of patients at inclusion and in 26.4% after t he first week, with a significant decrease in fat (P=.002) and viscera l protein compartments (P=.049). Malnourished patients showed higher s tress reaction and increased frequency of infections and bedsores in c omparison with the appropriately nourished group. Multiple logistic re gression analysis showed that malnutrition after 1 week (odds ratio, 3 .5; 95% confidence interval, 1.2 to 10.2) and elevated free urinary co rtisol (odds ratio, 3.3; confidence interval, 1.05 to 10.2) increased the risk of poor outcome (death or Barthel Index less than or equal to 50 on the 30th day of follow-up) independently of age and nutritional status at admission, Conclusions Our findings suggest that protein-en ergy malnutrition after acute stroke is a risk factor for poor outcome . Early appropriate enteral caloric feeding did not prevent malnutriti on during the first week of hospitalization.