Malnutrition determined by the patient-generated subjective global assessment is associated with poor outcomes in acute stroke patients

ASSOCIATION BETWEEN SUBJECTIVE GLOBAL ASSESSMENT (SGA) OUTCOMES AND STROKE SEVERITYABSTRACTIntroduction: Stroke is a cerebrovascular disease caused by the sudden death of brain cells. Nutrition plays an important role in stroke. Inadequate intake of nutrients affects severity of stroke. Subjective Global Assessment (SGA) can be used to assess the nutritional status of stroke patients, while severity of stroke is known by assessing neurological deficits based on the National Institute of Health Stroke Scale (NIHSS).Aims: To determine the association between SGA outcomes and stroke severity based on NIHSS.Methods: A cross-sectional study with consecutive sampling in stroke patients who were treated in the neurological ward of Dr. Hasan Sadikin Hospital, Bandung between August-October 2018. Subjective Global Assessment and NIHSS were assessed. Alternative statistical test Fisher’s exact test was used to see the relationship between these two variables.Results: Among 40 patients, 57.5% were female, 37.5% had a stroke at the age of 50-59 years, the main risk factor of stroke was hypertension. Recurrence stroke were more common (52.5%), with most of them were ischemic stroke (60%). The most common neurological deficit was hemiplegia. Subjects with malnutrition (SGA C) were 40%. Fifty percent patients had moderate neurological deficits based on NIHSS. The association between variables by Fisher’s exact test was 0.008.Discussion: There was a significant association between SGA outcomes and stroke severity based on NIHSS.Keywords: NIHSS, nutritional status, SGA, stroke severityABSTRAKPendahuluan: Stroke merupakan penyakit serebrovaskular yang disebabkan adanya kematian mendadak sel otak. Nutrisi berperan penting pada stroke. Asupan nutrisi yang tidak adekuat berpengaruh terhadap derajat keparahan stroke. Subjective Global Assessment (SGA) dapat menilai status gizi pasien stroke, sedangkan derajat keparahan stroke diketahui dengan menilai defisit neurologis berdasarkan National Institute of Health Stroke Scale (NIHSS).Tujuan: Mengetahui hubungan antara luaran SGA dengan derajat keparahan stroke berdasarkan NIHSS.Metode: Analisis potong lintang dengan consecutive sampling pada pasien stroke yang dirawat di bangsal Neurologi RSUP Dr. Hasan Sadikin, Bandung bulan Agustus-Oktober tahun 2018. Variabel yang dinilai pada penelitian adalah SGA dan NIHSS. Uji alternative Fisher’s exact test digunakan untuk melihat hubungan antar variabel.Hasil: Dari 40 subjek penelitian sebanyak 57,5% berjenis kelamin perempuan, 37,5% mengalami stroke pada usia50–59 tahun, memiliki faktor risiko utama hipertensi. Stroke berulang lebih banyak terjadi (52,5%), jenis stroke terbanyak adalah iskemik (60%). Defisit neurologis terbanyak yaitu hemiplegia. Subjek dengan gizi buruk (SGA C) sebanyak 40%. Derajat keparahan NIHSS dengan defisit neurologis sedang yaitu 50%. Hubungan antar kedua variabel, uji alternative Fisher’s exact test memperoleh hasil 0,008.Diskusi: Terdapat hubungan yang bermakna antara luaran SGA dengan derajat keparahan stroke berdasarkan NIHSS.Kata kunci: Derajat keparahan stroke, NIHSS, SGA, status gizi

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Abstract WP378: Characteristics and Outcomes of Stroke Patients Transferred to Hospitals Participating in the Michigan Coverdell Acute Stroke Registry 2009-2011

Stroke ◽

10.1161/str.44.suppl_1.awp378 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Stacey Roberts ◽

Adrienne Nickels ◽

Erin Shell ◽

Marylou Mitchell ◽

Syed Hussain ◽

...

Keyword(s):

Acute Stroke ◽

Systems Of Care ◽

Clinical Care ◽

Stroke Patients ◽

Stroke Length ◽

Stroke Registry ◽

Logistic Regression Models ◽

Vein Thrombosis ◽

Transferred Patients ◽

Poor Outcomes

Characteristics and Outcomes of Stroke Patients Transferred to Hospitals Participating in the Michigan Coverdell Acute Stroke Registry, 2009-2011 Background: As stroke systems of care are evolving the number of stroke patients transferred between hospitals is increasing. Our objectives were to describe the characteristics of acute stroke patients who were transferred to hospitals participating in the Michigan Coverdell Acute Stroke Registry, and to determine the independent association between transfer status (TS) and in-hospital mortality (IHM) and in-hospital complications (IHC). Methods: From 2009-2011, 30934 acute ischemic (IS) and hemorrhagic stroke (HS) patients were admitted to 35 registry hospitals. Patients with an in-hospital stroke, TIA, or unknown arrival mode were excluded (N= 14,732). Independent factors associated with TS and predictors of IHC (defined as deep vein thrombosis, pneumonia, and/or UTI) were identified using multivariable logistic regression models. Results: The mean age of the 16202 admissions was 69.2 years, 51% were female, 68% were white, 83% had an IS, 7.4% died in-hospital, and 13.8% had an IHC. Overall, 19% (N= 3091) were transferred to a registry hospital. The transfer rate increased from 2009-2011 (16.9% -21.1%), and was higher in HS vs. IS patients (37.6% vs. 15.3%). Significant predictors of TS were year, age, gender, race, stroke type, pre-stroke ambulatory status, nursing home residence, and medical history of diabetes or prior stroke. Length of stay (LOS) was longer for transferred patients vs. non-transferred (7.9 vs. 5.3 days, p<0.0001). Transferred patients were more likely to die in-hospital vs. non-transferred (12.0% vs. 6.4%, P <0.001), and develop IHC (18.4% vs. 12.8%, P < 0.001). After adjusting for confounding variables, TS remained a significant predictor of IHM (adjusted odds ratios [aOR] = 1.46, 95%CI =1.14- 1.88), and IHC (aOR= 1.58, 95%CI =1.34- 1.87). Conclusions: The frequency of hospital transfers increased markedly in this registry. Transferred patients experience higher rates of IHM, IHC and longer LOS. Further studies are needed to understand the relationship between TS and outcomes and the implication for improved clinical care and reducing poor outcomes in this higher risk group.

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Low Baseline Urine Creatinine Excretion Rate Predicts Poor Outcomes among Critically Ill Acute Stroke Patients

Current Neurovascular Research ◽

10.2174/1567202612666150102151455 ◽

2015 ◽

Vol 12 (1) ◽

pp. 47-52 ◽

Cited By ~ 5

Author(s):

Chia-Yu Hsu ◽

Yi-Ling Wu ◽

Chun-Yu Cheng ◽

Jiann-Der Lee ◽

Ying-Chih Huang ◽

...

Keyword(s):

Acute Stroke ◽

Critically Ill ◽

Excretion Rate ◽

Stroke Patients ◽

Creatinine Excretion ◽

Urine Creatinine ◽

Poor Outcomes ◽

Creatinine Excretion Rate

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Subjective global assessment of malnutrition and dysphagia effect on the clinical and Para-clinical outcomes in elderly ischemic stroke patients: a community-based study

BMC Neurology ◽

10.1186/s12883-021-02501-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mahsa Mahmoudinezhad ◽

Mohammad Khalili ◽

Nasim Rezaeemanesh ◽

Mehdi Farhoudi ◽

Sharareh Eskandarieh

Keyword(s):

Clinical Outcomes ◽

Global Assessment ◽

Univariate Analysis ◽

Nutrition Status ◽

Subjective Global Assessment ◽

Stroke Patients ◽

Discharge Time ◽

Biochemical Tests ◽

Positive Correlation ◽

Arm Circumference

Abstract Background Malnutrition as a result of insufficient intake or uptake of nutrition leads to increasing rate of chronic diseases such as stroke. Stroke is one of the most common causes of death in western countries and its increasing trend has attracted lots of attention. In this regard, it seems logical to focus on modifiable risk factors such as nutrition, in order to reduce the resulting complications. Accordingly, this study aimed at evaluating nutrition status of stroke patients to estimate its relationship with clinical outcomes of stroke. Methods In the present cross-sectional study, 349 patients were recruited. Nutrition assessment was performed using Patient-Generated Subjective Global Assessment (PG-SGA). In addition, National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and biochemical tests were performed. Results Our findings elucidated a significant positive correlation of mRS with PG-SGA and consciousness score, as well as a negative correlation with BMI, calf circumference, mid-arm circumference, and triceps skinfold at admission time (P ≤ 0.002). Moreover, a direct correlation was found between mRS and PG-SGA and consciousness score at discharge time (P ≤ 0.001). In contrast, an inverse correlation was established between mRS and mid-arm circumference (P = 0.02). Furthermore, univariate analysis indicated significant associations between mRS ≥ 3 and age (OR: 1.02; 95%CI: 1.00–1.04), PG-SGA (OR: 1.08; 95%CI: 1.03–1.13), NIHSS (OR: 1.04; 95%CI: 1.02–1.07), dysphagia (OR: 1.69; 95%CI: 1.03–2.77), consciousness (OR: 1.48; 95%CI: 1.07–2.04), and mid-arm circumference (OR: 0.95; 95%CI: 0.90–1.00). In addition, these associations remained significant in multivariate analysis for PG-SGA (OR: 1.07; 95%CI: 1.00–1.13) and NIHSS (OR: 1.04; 95%CI: 1.01–1.07). Conclusion This study revealed a positive correlation between mRS and consciousness status and PG-SGA score, as well as a negative one between mRS and MAC at discharge time.

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The role of nursing in the rehabilitation of acute stroke patients: Toward a unified theoretical perspective

Pflege ◽

10.1024/1012-5302.12.1.21 ◽

1999 ◽

Vol 12 (1) ◽

pp. 21-27

Author(s):

Marit Kirkevold

Keyword(s):

Acute Stroke ◽

Theoretical Perspective ◽

Stroke Patients ◽

Role Of Nursing ◽

Rolle Der Pflegenden

Eine Übersicht der bestehenden Literatur weist auf Unsicherheiten bezüglich der spezifischen Rolle der Pflegenden in der Rehabilitation von Hirnschlagpatientinnen und -patienten hin. Es existieren zwei unterschiedliche Begrifflichkeiten für die Rolle der Pflegenden, keine davon bezieht sich auf spezifische Rehabilitationsziele oder Patientenergebnisse. Ein anfänglicher theoretischer Beitrag der Rolle der Pflege in der Genesung vom Hirnschlag wird als Struktur unterbreitet, um die therapeutischen Aspekte der Pflege im Koordinieren, Erhalten und Üben zu vereinen. Bestehende Literatur untermauert diesen Beitrag. Weitere Forschung ist jedoch notwendig, um den spezifischen Inhalt und Fokus der Pflege in der Genesung bei Hirnschlag zu entwickeln.

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