Association of risk of malnutrition with adverse outcomes and early support on discharge in acute stroke patients without prestroke disability: a multi-centre registry-based cohort study

David Fluck, Chris H Fry, Giosue Gulli, Brendan Affley, Jonathan Robin, Puneet Kakar, Pankaj Sharma, Thang S Han*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Background: Malnutrition in hospitals remains highly prevalent. As part of quality improvement initiatives, the RCP recommends nutrition screening for all patients admitted with acute stroke. We aimed to examine the associations of patients at risk of malnutrition with outcomes following an acute stroke and their requirements of early support on discharge.
Methods: We analysed prospectively collected data from four hyperacute stroke units (HASU) (2014-2016). Nutritional status was screened in 2962 acute stroke patients without prestroke disability (1,515 men, mean age±SD=73.5yr ±13.1, and 1,447 women, 79.2yr±13.0). The risk of malnutrition was tested against stroke outcomes and support on discharge, adjusted for age, sex, and comorbidities using logistic regression.
Results: Risk of malnutrition was identified in 25.8% of patients; all of whom were reviewed by a dietitian by 1.3days (IQR=0.3-3.2). Compared to well-nourished patients, those at risk of malnutrition had, within 7days of admission, increased risk of poststroke adverse outcomes including: LOS on HASU>14 days, OR=9.9 (7.3-11.5); disability on discharge, OR=8.1 (6.6-10.0); worst level of consciousness in the first 7-days (score≥1), OR=7.5 (6.1-9.3); mortality, OR=5.2 (4.0-6.6); pneumonia, OR= 5.1 (3.9-6.7) and urinary tract infection, OR =1.5 (1.1-2.0). They also required greater support on discharge including: palliative care, OR =12.3 (8.5-17.8); discharge to new care home, OR=3.07 (2.18-4.3); activities of daily living support, OR=1.8 (1.5-2.3); planned joint-care, OR=1.5 (1.2-1.8) and weekly visits, OR=1.4 (1.1-1.8).
Conclusions: Patients at risk of malnutrition more commonly have multiple adverse outcomes following acute stroke and greater need for early support on discharge.
Original languageEnglish
JournalNutrition in Clinical Practice
Publication statusPublished - 19 Sep 2021

Keywords

  • nutrition
  • healthcare
  • disability
  • mortality

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