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Various effects of nutritional status on clinical outcomes after intracerebral hemorrhage

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Abstract

Although the assessment of nutrition is essential for stroke patients, detailed associations between nutritional status at admission, subsequent complications, and clinical outcomes in patients with acute intracerebral hemorrhage (ICH) are unclear. We aimed to elucidate these associations using the Controlling Nutritional Status (CONUT) score. Consecutive patients with acute ICH were investigated. Nutritional status was evaluated using the CONUT score, calculated from the serum albumin level, lymphocyte count, and total cholesterol level. Subsequent complications, such as hemorrhage expansion (HE) during the acute stage and aspiration pneumonia during hospitalization, were evaluated. Poor outcome was defined as a modified Rankin Scale score of ≥ 3 at 3 months. Of the 721 patients, 49 had HE, 111 had aspiration pneumonia, and 409 had poor outcomes. Patients with HE had significantly lower total cholesterol levels than those without HE. Patients with aspiration pneumonia had significantly lower albumin levels, lower lymphocyte counts, and higher CONUT scores than those without aspiration pneumonia. Patients with poor outcomes had significantly lower albumin levels, lower lymphocyte counts, lower total cholesterol levels, and higher CONUT scores than those with good outcomes. Multivariable logistic analysis showed that higher CONUT scores were independently associated with poor outcome (odds ratio, 1.28; 95% confidence interval, 1.09–1.49; P = 0.002) after adjusting for baseline characteristics, HE, and aspiration pneumonia. Each component of CONUT was a useful predictor of subsequent complications. Malnutrition, determined using the CONUT score, was independently associated with poor outcomes in patients with ICH after adjusting for these complications.

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Funding

This study was supported by research grants from the Japan Society for the Promotion of Science KAKENHI (Grant numbers: 20K16579).

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Authors and Affiliations

  1. Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Yuji Shiga, Tomohisa Nezu, Shiro Aoki & Hirofumi Maruyama

  2. Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan

    Ryo Shimomura, Kota Sato, Takahiro Himeno, Yuka Terasawa & Tatsuo Kohriyama

  3. Department of Neurology, Chikamori Hospital, Kochi, Japan

    Naohisa Hosomi

  4. Department of Disease Model, Research Institute of Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    Naohisa Hosomi

Authors
  1. Yuji Shiga
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  2. Tomohisa Nezu
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  3. Ryo Shimomura
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  4. Kota Sato
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  5. Takahiro Himeno
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  8. Naohisa Hosomi
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  10. Hirofumi Maruyama
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Contributions

Conceived and designed the experiments: YS, TN, RS, KS, TH, YT, SA and TK. Performed the experiments: YS, TN, RS, KS, TH, YT, SA and TK. Analyzed the data: YS and TN. Contributed reagents/materials/analysis tools: TN, RS, KS, TH, YT, SA, and TK. Wrote the paper: YS, TN, NH, TK, and H Maruyama.

Corresponding author

Correspondence to Tomohisa Nezu.

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Conflict of interest

Dr. Maruyama received Grants-in-Aid for Scientific Research (20K07887) and research support from Eisai, Pfizer, Takeda Pharmaceutical, Otsuka Pharmaceutical, Nihon Pharmaceutical, Shionogi, Teijin Pharma, Fuji Film, Sumitomo Dainippon Pharma, Nihon Medi-Physics, Bayer, MSD, Daiichi Sankyo, Kyowa Hakko Kirin, Sanofi, Novartis, Kowa Pharmaceutical, Astellas Pharma, Tsumura, and Japan Blood Products Organization, which are unrelated to the submitted work. All other authors declare that they have no conflict of interest.

Ethical approval

This study complied with the Declaration of Helsinki for investigations involving humans, and the study protocol was approved by the Ethics Committee of the Brain Attack Center Ota Memorial Hospital (217).

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The requirement for informed consent was waived by the ethics committee considering the retrospective, noninterventional nature of the study.

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The data that support the findings of this study are available from the corresponding author on reasonable request.

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Shiga, Y., Nezu, T., Shimomura, R. et al. Various effects of nutritional status on clinical outcomes after intracerebral hemorrhage. Intern Emerg Med 17, 1043–1052 (2022). https://doi.org/10.1007/s11739-021-02901-x

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