Background: Malnutrition is an independent risk factor of poor outcome in acute ischemic stroke patients, but the indicator of malnutrition has not been well-established. The Controlling Nutritional Status (CONUT) score is reported to be a useful prognostic value of malnutrition in the cardiovascular diseases and malignant tumors. We investigated the relationship between the CONUT score and functional outcomes in acute ischemic stroke patients.
Method: Acute ischemic stroke patients (n=264, 70±12 years old) within 7 days of stroke onset were consecutively studied. The CONUT score was calculated from the serum albumin, total peripheral lymphocyte count and total cholesterol and the CONUT score ≥5 was defined as malnutrition. In the present study, we obtained the blood samples for the CONUT score within 2 days after admission. The primary outcome was evaluated from the 3-month functional status: poor outcome as a modified Rankin Scale (mRS) score ≥ 3 and good outcome as a mRS score <3.
Results: Of the total enrolled cohort, 230 patients (87.1%) were assessed for the functional outcomes. The patients with poor outcome (n=85) were older, lower body mass index (BMI), and more frequently had atrial fibrillation, chronic heart failure and anemia, and less frequently had dyslipidemia and current smoking. In addition, the CONUT score and National Institutes of Health Stroke Scale (NIHSS) score at admission were significantly higher in the patients with poor outcome. As the CONUT score was higher, the proportion of patients with poor functional outcome increased, and the poor functional outcome exceed 70% when the score was ≥ 5. Univariate logistic analyses showed that the CONUT score ≥5 was significantly associated with poor outcome at 3 months (odds ratio [OR] 6.05, 95% confidence interval [CI] 2.95-13.09, P<0.001). After multivariate analysis, the CONUT score ≥5, initial NIHSS score, and current smoking were independently associated with poor outcome (OR 4.15, 95% CI 1.52-11.67, P=0.005, OR 1.23, 95%CI 1.15-1.34, P<0.001, OR 0.14, 95%CI 0.03-0.53, P=0.002, respectively).
Conclusion: The CONUT score at admission is expected to be a useful prognostic marker of a 3-month functional outcome in acute ischemic stroke patients.