22. European Stroke Conference 65 Stroke prognosis Risk of malnutrition, Body Mass Index and Waist Circumference as predictors of mortality af-ter 312 © 2013 S. Karger AG, Basel Scientific Programme stroke F. Gomes1, P. Emery2, E. Weekes3 King´s College London, London, UNITED KINGDOM1, King’s College London, , UNITED KINGDOM2, Guy’s and St Thomas’ NHS Foundation Trust, London, UNITED KINGDOM3 Introduction Several recent studies have shown a paradoxical association between Body Mass Index (BMI) and mortality after stroke. This better survival of overweight and obese patients needs to be scrutinized. The aim of this study is to compare the associations between BMI, waist circumference (WC), risk of malnutrition and mortality at 6 months after a stroke. Methods Patients were recruited from consecutive admissions at 2 hyper-acute stroke units based in London and, after assessment, they were divided into 4 categories of BMI (underweight, normal weight, overweight and obese), quartiles of WC and 3 groups of risk of malnutrition (low, medium and high, according to two nutrition screening tools). NHS summary care records were reviewed to obtain mortality data for each patient at 6 months post admission. Chi-square tests were used to compare mortality rates and Cox Proportional Hazards Models were used to compare mortality risk and survival curves between different BMI categories, WC quartiles and nutritional risk groups. Results Of 543 recruited patients, 51% were males and 87% had an ischaemic stroke, with a mean age of 74.7years (range 22–99). As shown on table 1 (attached), there were significant inverse associations between BMI and WC and risk of mortality at 6-months post-stroke, i.e., the higher the BMI category and the WC quartile, the lower the risk of mortality (p=0.002 and p=0.042, respectively). However, after adjustment for possible confounders (age, ethnicity, gender, severity and type of stroke), the significant associations disappeared (p=0.259 and p=0.197, respectively). For both nutrition screening tools, the higher the risk of malnutrition, the higher the risk of mortali-ty (p<0.001) and this association remained significant after the adjustment for possible confounders (p<0.001). Conclusion Risk of malnutrition is a better predictor of mortality at 6 months post-stroke than BMI or WC. Table 1 Number of pati-ents Mortality rates (Chi-square test) Univariate Cox Pro-portional Hazards Model Multivariable* Cox Proportional Hazards Model HR 95%CI HR 95%CI Body Mass Index cat-egories (p values) 543 p=0.002 p=0.002 p=0.259 Underweight (<18.5 kg/m2) 38 28.9% 1.18 0.62-2.28 1.1 0.57-2.14 Normal weight (18.5-24.9 kg/m2) 206 23.8% Reference group Reference group Overweight (25-29.9 kg/m2) 177 14.4% 0.048 0.29-0.79 0.69 0.41-1.17 Obesity (>30 kg/m2) 122 11.5% 0.43 0.24-0.79 0.61 0.33-1.124 Waist Circumference Quartiles (p values) 542 p=0.042 p=0.042 p=0.197 1st quartile (<88cm) 146 25.3% Reference group Reference group 2nd quartile (89 - 98cm) 143 16.1% 0.61 0.36-1.02 0.61 0.36-1.06 3rd quartile (99 – 108cm) 118 14.4% 0.54 0.30-0.95 0.62 0.34-1.14 4th quartile (>109cm) 135 14.1% 0.51 0.29-0.89 0.59 0.33-1.07 Guy’s and St. Thom-as’ Nutrition Screen-ing Tool (p values) 543 p<0.001 p<0.001 p<0.001 Low risk 320 5.6% Reference group Reference group Medium risk 52 13.5% 2.5 1.05-5.99 2.07 0.86-4.97 High risk 171 41.5% 9.64 5.74-16.18 5.59 3.25-9.64 Malnutrition Univer-sal Screening Tool (p values) 537 p<0.001 p<0.001 p<0.001 Low risk 342 6.1% Reference group Reference group Medium risk 39 25.6% 4.65 2.19-9.89 3.51 1.63-7.63 High risk 156 41.7% 8.82 5.39-14.44 4.92 2.91-8.33
Karger_ESC London_2013
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