The Study About The Nutritional Assessment And Clinical Outcome Of Senile Inpatients With Acute Cerebrovascular Disease And Groups With High-risk Factor Of Stroke In Community

Objective:To investigate the incidence of nutrition risk in high-risk groups with stroke from Community and cerebrovascular disease senile inpatients,comparative analysis the relationship between the different nutrition state evaluated by various method of nutritional assessment and clinical outcomes.To explore suitable method of nutritional assessment for cerebrovascular disease senile inpatients,provide basis and instruction for clinical nutrition evaluation and support.Methods:Part one:A cross sectional study was carried out on592high-risk groups with stroke in Community who were from Yue xiu street and Tao yuan street,between January14st2013to Januiary25th2013. Mini nutritional assessment(MNA) and Mini-Nutritional Assessment-Short Form t(MNA-SF) and Mini Mental State Exam (MMSE) were adopted and the results was analyzed.Part two:The Nutritional Risk Screening2002(NRS2002), Mini-Nutritional Assessment-Short-Form (MNA-SF, National Institutes of Health Stroke Scale Scale(NIHSS) and Laboratory indicators were administrated to321cerebrovascular disease senile inpatients aged65+y,within48h of hospital admission,between March1st2012to May30th2012. Comparative analysised the difference of nutrition state of different cerebrovascular disease classification, different age groups, and the NIHSS score.Tool performance in predicting complications, very long length of hospital stay (LOS), and hospitalization costs was analyzed.Results:Part one:1.491patients with completed information from592cases of screening patients. Using the MNA, subjects were classified as follows:malnourished (n=6,1.22%); at risk of malnutrition (n=126,25.67%) and well nourished (n=359,73.12%). Using the MNA-SF, subjects were classified as follows:malnourished (n=2,0.41%); at risk of malnutrition (n=60,12.22%) and well nourished (n=429,87.37%).2. The kappa statistic for level of agreement between classification using the MNA-SF and the full MNA was0.564(P=0.000). MNA-SF score was correlated with total MNA score (Spearman r=0.768(P=0.000)).Sensitivity,using an MNA-SF score of0-11to identify "nutrition risk"subjects, was49.0%,while specificity of theMNA-SF (ie. Proportion of "true" well nourished that were identified) was98.0%. The proportion of people screened by the MNA-SF that werecorrectly classified as nutrition risk (ie. positive predictive value) was98.0%. The negative predictive value(NPV; proportion of people screened by MNA-SF that werecorrectly classified as well nourished) was85.7%.3. Single factor analysis,subjects are easy to nutritional risk which with history of diabetes, stroke, less vegetable diet, less physical exercise or light manual labor, prescription drugs≥3per day, lower MMSE scores and older age (P＜0.05).4. Logistic regression analysis, history of diabetes, less physical exercise or light manual labor, prescription drugs≥3per day, older age are the risk factor for nutrition risk(p<0.05).5.Independent-Samples-Test, subjects have be lower MMSE scores which is with history of stroke,prescription drugs≥3per day, hyperhomocysteinemia and nutrition risk identified by MNA(P＜0.05).Part two:1. The characteristics of the321cerebrovascular disease senile impatients evaluated in this study. Using the NRS2002, subjects were classified as follows:nutritional risk (n=226,70.40%); and well nourished (n=95,29.60%). Using the MNA-SF, subjects were classified as follows:malnourished (n=132,41.10%); at risk of malnutrition (n=88,27.40%) and well nourished (n=101,31.50%).2. According to NRS2002assess, compared with the low age group, the incidence of nutritional riskin is higher in medium and higher age group(P＞0.05). According to the MNA-SF assess, compared with middle and low age group, the high age group have a higher incidence of malnutrition and risk of malnutrition(P＜0.05).3. The difference have statistical significance between stroke and cerebrovascular disease than stroke(p＜0.05).4. The difference have statistical significance between NIHSS score>8and NIHSS score≤8(p＜0.05).5. The kappa statistic showed strongly agreement was0.956(P=0.000) between NRS2002and MNA-SF. MNA-SF score was correlated with total NRS2002score (Spearman r=0.829,P=0.000)).6. according to the classifications of the NRS2002and the MNA-SF,The nutrition indexes(anthropometric measurements and biochemical markers) were on a declining curve with worse of the nutrition state,there are statistical significance with BMI、AC、CC、ALB、HB、TLC(p＜0.05) 7. Of the284cases with completed outcomes indicators,32.39%(n=92)had infection complications,16.55%(n=47)had non-infection complications.8. The incidence of infection complications of nutrion risk identified by NRS2002and MNA-SF or malnutrition identified by ALB、HB、TLC、TP,is higher than well nourished(p＜0.05)9. The incidence of non-infection complications of nutrion risk identified by NRS2002and MNA-SF or malnutrition identified by ALB、TLC is higher than well nourished(p＜0.05)10. The LOS and hospitalization costs of nutrion risk identified by NRS2002and MNA-SF or malnutrition identified by ALB、HB、TLC、TP、TG、TC,are higher than well nourished. The difference have statistical significance between nutrion risk identified by NRS2002and MNA-SF or malnutrition identified by TLC and well nourished.11. Single factor analysis,subjects are easy to infection complications who is with history of diabetes, stroke, NIHSS>8, age≥75, Below normal lymphocyte count, The lack of nutrition support and nutrion risk identified by NRS2002and MNA-SF (P＜0.05). Logistic regression analysis, The difference have statistical significance between diabetes, age≥75, Below normal lymphocyte count, The lack of nutrition support, higher NIHSS scores,nutrion risk identified by NRS2002and MNA-SF (p＜0.05) and normal.Conclusions:1. Malnutrition risk is still account for a certain proportion to25.67%and12.22%in high-risk groups with stroke in Community.The incidence of nutrition risk are higher in cerebrovascular disease senile impatients to70.4%and68.5%,special in the advanced age、stroke patients and serious Nerve function deficient patients.2. History of diabetes, less physical exercise or light manual labor, prescription drugs≥3per day, older age are the risk factor for nutrition risk.3. Subjects have be lower MMSE scores who is with history of stroke,prescription drugs≥3per day, nutrition risk identified by MNA.4. High-risk groups with stroke in community with hyperhomocysteinemia is prone to mild cognitive impairment. 5. Cerebrovascular disease senile impatients who have got diabetes, severe neurologic deficits is easy to concurrent infectious complications.6. The traditional nutritional index, lymphocyte count, total protein, albumin, hemoglobin in senile cerebrovascular disease acute stage is lower than normal, can predict infectious cocomplications.7. The study findings revealed the nutritional risk patients identified by NRS2002and MNA-SF had more complications, higher mortality, longer lengths of stay, and more cost than not at-risk patients. Speculated that nutritional risk has a certain predictability for infectious complications, and nutritional support is protective factors to prevent infectious complications.8. Compared with the MNA,MNA-SF have higher specificity,lower sensitivity, lower rate of false positives.MNA-SF is suitable for older population with high-nutrion-risk.9. NRS2002and MNA-SF as nutrition assessment tool, and its sensitivity to the prediction of adverse clinical outcome is better than the traditional measurements.The MNA-SF allows BMI replaced with calf circumference easily measured, more suitable for adverse action senile patients with cerebrovascular disease.It is worthy of clinical recommendations.10.It is should pay attention to high-risk groups with stroke and elderly patients with cerebrovascular disease in hospital that nutrition risk screening. Strengthening propaganda education and nutrition management, establishing nutrition evaluation diagnosis records and formulating nutrition risk interventions, are in order to reduce the incidence of adverse clinical outcomes of senile impatients with cerebrovascular disease.