

Protein-energy malnutrition in patients with neurogenic dysphagia in acute period of ischemic stroke
Heading: Neurology Article type: Original article
Authors: Borzdyko А.А., Ershov V.I.
Organization: Clinical Hospital n. a. N. I. Pirogov, Orenburg, Russia
Objective: to evaluate the effects of protein-energy malnutrition (РЕМ) on the course and outcome of ischemic stroke (IS) in patients with neurogenic dysphagia (ND). Material and methods. The study was performed in 110 patients (64 men and 46 women aged 44-89 years) using the National Institutes of Health Stroke Scale, Nutrition Risk Screening (NRS) 2002, Mann Assessment of Swallowing Ability (MASA). The level of total blood protein was measured at admission and on the day 10 of IS. The weight of patients was determined at admission and on the day 10 of the disease. The results of IS were analyzed according to the Glasgow Outcome Scale (GOS) and the frequency of complications: pneumonia, pulmonary embolism, phlebothrombosis, multiple organ failure, bedsores. Results. All patients with ND and IS at admission on the NRS 2002 scale had at least 3 points, signs of mild РЕМ were observed in 5.45%. On day 10, signs of РЕМ were observed in 40.9% of patients, of which mild in 20% of patients, moderate in 13.6% of patients and severe in 7.3% of patients. Differences between the level of total protein in the blood of patients with ND in IS at admission and on the day 10 from the onset of the disease were significant in all groups according to the severity of dysphagia on the MASA (p<0,001). In patients with clinical manifestations of РЕМ, the incidence of pneumonia, multiple organ failure and bedsores was statistically significantly higher than in patients without clinical manifestations of РЕМ. As a consequence of the complications that developed, a negative outcome on the GOS (1 point — death) was more common in patients with signs of РЕМ, and a positive outcome (4 points) in patients without signs of РЕМ (p=0.049). Conclusions. ND in the acute period of IS is one of the factors of the development of РЕМ, which aggravates the severity of the condition of patients, entails a number of complications and more often leads to a fatal outcome.
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