EVALUATION OF NUTRITIONAL STATUS IN PATIENTS AFTER ACUTE STROKE

UoM administered thesis: Master of Philosophy

  • Authors:
  • Yassin Kama

Abstract

Evaluation of nutritional status in patients after acute stroke Background: Malnutrition is a major complication that occurs in people after stroke both during admission to the hospital and in the weeks after ictus. Many studies have been conducted to evaluate nutritional status in these patients using several techniques including the Malnutrition Universal Screening Tool (MUST). However, current evidence is limited and the effects of malnutrition after stroke on clinical outcomes remain unclear. The aim and objectives: The aims of these studies were to ascertain whether being malnourished on admission with stroke is associated with poorer clinical outcome. Methods: Initially a systematic review was conducted where the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline (PRISMA) were applied. All studies were identified through searching electronic databases and checking reference lists of relevant articles. Medical subject headings (MeSH) were used to search titles and/or abstracts, with terms of: “nutrition in stroke”; “malnutrition in stroke”; “skeletal muscle wasting” and “stroke clinical outcome”. Then a retrospective cohort analysis has been performed of the Malnutrition Universal Screening Tool (MUST) in acute stroke in Salford Royal Hospital using patient information available from January 2013 to March 2016. Data were collected after matching between the Trust specific Sentinel Stoke National Audit Programme (SSNAP) and Electronic Patient records (EPR). Overall, 1,101 patients (539 males and 562 females) were retrieved for analysis using linear regression and Chi-squared tests. Findings: The systematic review showed, in most studies, that nutritional screening tools can be used as independent predictors of clinical outcome, and highlighted the importance of nutritional status assessment as a routine procedure on hospital admission. The retrospective cohort study revealed that 66% of patients had MUST at admission. Most patients (78.5%) had no risk of malnutrition, 17.3% had high risk, and 4.1% had medium risk. Additionally, the association between risk of malnutrition and clinical outcomes was statistically significant and proportional (i.e. the greater the risk of malnutrition, the higher the possibility of poorer outcomes). For those who had greater risk of malnutrition their hospital stay was longer (P˂ 0.04), mortality was higher both within the hospital admission (P˂ 0.001), and at 6 months follow-up (P˂0.001), and infections more prevalent (P˂ 0.001). Summary/conclusion: The application of the MUST as an independent predictor of clinical outcomes can be used in health care settings with reference to acute stroke. Therefore, early identification of risk of malnutrition in stroke and future provision of early nutritional interventions is likely to become an important priority for the health services in the UK with potential improved clinical outcomes and resources saving.

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Original languageEnglish
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Award date1 Aug 2018