Predictive Value of Nutritional Risk for All-Cause Death and Functional Outcomes in Chinese Elderly Patients with Acute Stroke: A 3-Year Follow-Up Study

Figures & data

Figure 1 Flow chart of the patient inclusion process.

Table 1 Baseline Characteristics Stratified by the Mortality

Characteristics	3 Months Post Discharge				3 Years Post Discharge
	Total (n=479)	Alive (n=453)	Dead (n=26)	P value	Total (n=364)	Alive (n=261)	Dead (n=103)	P value
Age, years, median (IQR)	74 (69 ~ 80)	73 (69 ~ 80)	82 (78 ~ 85)	<0.001	74 (69 ~ 80)	72 (68 ~ 78)	79 (73 ~ 83)	<0.001
Male, n (%)	278 (58.0)	266 (58.7)	12 (48.2)	0.207	216 (59.3)	159 (60.9)	57 (55.3)	0.329
BMI, kg/m^2	23.4 ± 3.50	23.36 ± 3.44	22.37 ± 4.28	0.047	23.32± 3.51	23.50 ± 3.33	22.86 ±3.90	0.054
Systolic pressure, mmHg	154.52 ± 24.29	154.44 ± 23.01	161.15 ± 30.10	0.283	154.78 ± 24.99	153.14 ± 23.20	158.94 ± 28.76	0.064
Diastolic pressure, mmHg	82.36 ± 14.01	82.00 ± 13.83	88.27 ± 18.41	0.103	82. 45± 14.72	82.10 ± 14.07	83.33 ± 16.29	0.548
Hypertension, n (%)	341 (71.2)	320 (70.6)	21 (80.8)	0.267	258 (70.9)	177 (67.8)	81 (78.6)	0.041
Diabetes mellitus, n (%)	151 (31.5)	145 (32.0)	6 (23.1)	0.929	107 (29.4)	70 (26.8)	37 (35.9)	0.086
Hyperlipidemia, n (%)	192 (40.1)	108 (40.2)	10 (38.5)	0.862	147 (40.4)	111 (42.5)	36 (35.0)	0.184
Coronary heart disease, n (%)	31 (6.5)	28 (6.2)	3 (11.5)	0.280	24 (6.6)	14 (5.4)	10 (9.7)	0.132
Atrial fibrillation, n (%)	51 (10.6)	46 (10.2)	5 (19.2)	0.192	41 (11.3)	28 (10.7)	13 (12.6)	0.607
History of smoking, n (%)	147 (30.7)	142 (31.3)	5 (19.2)	0.929	120 (33.0)	84 (32.2)	36 (35.0)	0.613
History of alcohol use, n (%)	146 (30.5)	139 (30.7)	7 (27.0)	0.685	110 (30.2)	83 (31.8)	27 (26.2)	0.296
History of stroke, n (%)	114 (23.8)	108 (23.8)	6 (23.0)	0.929	83 (22.8)	53 (20.3)	30 (29.1)	0.071
Laboratory data
Erythrocyte, × 10^12/l	4.21± 0.56	4.21± 0.56	4.29± 0.69	0.760	4.23± 0.56	4.27± 0.51	4.12± 0.65	0.045
Leukocyte, × 10^9/l	7.08± 2.49	6.95± 2.38	9.27± 3.27	<0.001	7.10± 2.60	6.77± 2.26	7.94± 3.18	<0.001
Hemoglobin, g/l	129.04± 17.41	129.3± 16.91	129.15± 79.00	0.543	129.59± 17.46	130.84± 15.28	126.43± 21.80	0.039
Platelet, × 10^9/l	212.29± 68.63	212.41± 66.57	210.15± 99.59	0.384	207.23± 63.23	208.17± 58.00	204.85± 74.10	0.277
Albumin, g/l	3.68± 0.36	3.68± 0.46	3.62± 0.26	0.204	3.69± 0.35	3.72± 0.35	3.63± 0.34	0.040
Baseline NIHSS, median (IQR)	3 (1 ~ 7)	3 (1 ~ 6)	10 (4 ~ 16)	<0.001	3 (1 ~ 7)	3 (1 ~ 6)	6 (3 ~ 12)	<0.001
NIHSS >8, n (%)	103 (21.5)	88 (19.4)	15 (57.7)	<0.001	86 (23.6)	43 (16.5)	43 (41.7)	<0.001
The Barthel index of ADL, median (IQR)	60 (35 ~ 85)	65 (35 ~ 85)	15 (5 ~ 40)	<0.001	60 (30 ~ 85)	70 (40 ~ 90)	30 (10 ~ 60)	<0.001
The Barthel index of ADL <60, n (%)	250 (52.2)	225 (49.7)	25 (96.2)	<0.001	197 (54.1)	119 (45.6)	78 (75.7)	<0.001

Abbreviations: ADL, activities of daily living; BMI, body mass index; GNRI, Geriatric Nutritional Risk Index; IQR, interquartile range; mRS, The Modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; NRS-2002, Nutritional Risk Screening.

Table 2 Correlations Between at of Malnutrition Risk (Screened by NRS-2002 and GNRI) and Mortality

NSTs	3-Month				3-year
	Total	Alive (n=453)	Dead (n=26)	p	Total	Alive (n=261)	Dead (n=103)	p
NRS-2002 score				0.014				0.012
≥ 3	317 (66.2)	294 (64.9)	23 (88.5)		250 (68.7)	166 (63.6)	84 (81.6)
< 3	162 (33.8)	159 (35.1)	3 (11.5)		114 (31.3)	95 (36.4)	19 (18.4)
GNRI score				0.016				<0.001
>98	161 (33.6)	159 (35.1)	2 (7.7)		119 (32.7)	97 (37.2)	22 (21.4)
92 ~ 98	176 (36.7)	163 (36.0)	13 (50.0)		140 (38.5)	96 (36.8)	44 (42.7)
<92	142 (29.7)	131 (28.9)	11 (42.3)		105 (28.8)	68 (26.0)	37 (35.9)

Notes: P values were calculated from the Chi-square test. Analysis was adjusted for the following covariates: the Barthel Index of ADL <60, baseline NIHSS >8, sex, BMI, systolic pressure, diastolic pressure, hypertension, diabetes mellitus, coronary heart disease, atrial fibrillation, hyperlipidemia, history of stroke, smoking and alcohol use.

Abbreviations: NST, nutrition screening tool.

Table 3 Multivariate Logistic Analysis of the Association Between at of Malnutrition Risk (Screened by NRS-2002 and GNRI) and Mortality

NSTs	3-month		3-year
	OR (95% CI)	P value	OR (95% CI)	P value
NRS-2002 score
≥ 3	3.642 (1.046 ~ 12.689)	0.042	2.266 (1.259 ~ 4.076)	0.006
GNRI score
>98	Reference		Reference
92 ~ 98	7.186 (1.550 ~ 33.315)	0.012	2.255 (1.211 ~ 4.199)	0.010
<92	6.535 (1.380 ~ 30.945)	0.018	2.498 (1.301 ~ 4.799)	0.006

Notes: Multivariate analysis: variables entered on backwards stepwise (conditional): NRS-2002 score or GNRI score, The Barthel Index of ADL <60, baseline NIHSS >8, sex, BMI, systolic pressure, diastolic pressure, hypertension, diabetes mellitus, coronary heart disease, atrial fibrillation, hyperlipidaemia, history of stroke, history of smoking, history of alcohol use.

Abbreviations: CI, Confidence Intervals; OR, Odds Ratio.

Table 4 Multivariate Logistic Analysis of the Association Between the Poor Prognosis and Nutritional Risk at Admission Screened by the GNRI

GNRI score	Mortality				mRS ≥3
	3 Months Post Discharge		3 Years Post Discharge		3 Months Post Discharge		3 Years Post Discharge
	OR (95% CI)	P	OR (95% CI)	P	OR (95% CI)	P	OR (95% CI)	P
>98	Reference		Reference		Reference		Reference
92 ~ 98	7.186 (1.550 ~ 33.315)	0.012	2.255 (1.211 ~ 4.199)	0.010	1.947 (1.030 ~ 3.680)	0.040		>0.1
<92	6.535 (1.380 ~ 30.945)	0.018	2.498 (1.301 ~ 4.799)	0.006	2.213 (1.144 ~ 4.279)	0.018		>0.1

Abbreviations: GNRI, Geriatric Nutritional Risk Index; mRS, Modified Rankin Scale; NST, nutrition screening tool; NRS-2002, Nutritional Risk Screening. P values were calculated from the Chi-square test.

Table 5 Multivariate Logistic Analysis of the Association Between at of Malnutrition Risk (Screened by NRS-2002 and GNRI) and Prognosis

NSTs	3-month		3-year
	OR (95% CI)	P value	OR (95% CI)	P value
NRS-2002 score
≥ 3	2.748 (1.518 ~ 4.972)	0.001	1.676 (0.957 ~ 2.934)	0.071
GNRI score
>98	Reference		Reference
92 ~ 98	1.947 (1.030 ~ 3.680)	0.040		> 0.1
<92	2.213 (1.144 ~ 4.279)	0.018		> 0.1

Notes: Multivariate analysis: variables entered on backwards stepwise (conditional): NRS-2002 score or GNRI score, The Barthel Index of ADL <60, baseline NIHSS >8, sex, BMI, systolic pressure, diastolic pressure, hypertension, diabetes mellitus, coronary heart disease, atrial fibrillation, hyperlipidaemia, history of stroke, history of smoking, history of alcohol use.

Figure 2 Comparison of the area under the receiver operating characteristic curve (AUROC) of the GNRI and NRS-2002 for the prediction of all-cause mortality (A) and poor functional recovery (B) at three months and all-cause mortality at three years (C).s.