Abstract
Malnutrition evidenced by low geriatric nutritional risk index (GNRI) has been
suggested as a potential predictor of poor prognosis of patients with various
clinical conditions. We performed a meta-analysis to systematically assess the
association between GNRI and the prognosis of patients after stroke. Cohort
studies were identified by search of PubMed, Embase, Cochrane’s Library
and Web of Science databases from inception to March 25, 2022, according to the
aim of the meta-analysis. A random-effect model incorporating the potential
between-study heterogeneity was used to pool the results. Eight cohort studies
with 13573 patients with stroke contributed to the meta-analysis. Pooled results
showed that malnutrition as evidenced by low GNRI was independently associated
with a higher risk of poor functional outcome [risk ratio (RR): 1.54,
95% confidence interval (CI): 1.19 to 1.98, p<0.001;
I2=69%] and an increased incidence of all-cause mortality (RR:
1.82, 95% CI: 1.35 to 2.47, p<0.001; I2=74%).
Sensitivity analyses showed consistent results in patients with ischemic stroke,
and in prospective cohort studies. Subgroup analyses showed that the
associations were not significant for patients with GNRI-defined mild
malnutrition (p=0.18 and 0.20 for functional and mortality outcomes,
respectively), but significant for patients with moderate-severe malnutrition
(both p<0.001). Difference in follow-up durations did not significantly
affect the associations (p for subgroup difference=0.75 and 0.70,
respectively). In conclusion, a low GNRI is associated with poor functional and
survival outcomes in patients after stroke.
Key words
geriatric nutritional risk index - malnutrition - stroke - mortality - meta-analysis
