营养不良通用筛查工具与急性缺血性卒中卒中相关性感染之间的关联：一项回顾性队列研究
Association between the malnutrition universal screening tool and stroke-associated infection in acute ischemic stroke: A retrospective cohort study.
文献信息
| PMID | 42753531 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Mayu Sasaki |
| 作者单位 | Division of Nutrition Management, Sendai City Hospital, 1-1-1, Asuto-nagamachi, Taihaku-ku, Sendai, Miyagi 982-8502, Japan. |
| 期刊 | Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia |
| SCI 分区 | Q3 |
| IF | 1.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 营养不良与急性缺血性卒中患者的不良结局相关，包括感染风险增加。营养不良通用筛查工具（MUST）广泛用于卒中患者的营养风险评估。然而，MUST评分与卒中相关性感染之间的关联仍不明确。本研究旨在探讨急性缺血性卒中患者入院时高MUST评分（≥2）与卒中相关性感染（SAI）之间的关联。
方法： 我们使用一项前瞻性卒中登记数据库开展回顾性队列研究。纳入2018年至2020年间连续入院的急性缺血性卒中患者。入院时的MUST评分由注册营养师进行回顾性评估。主要结局为SAI，包括医院获得性肺炎（HAP），次要结局为HAP。采用Fine-Gray竞争风险回归模型评估高MUST评分与结局之间的关联，将院内死亡和存活出院作为竞争事件。还根据年龄、性别、卒中严重程度和吞咽困难状态进行了探索性亚组分析。
结果： 在789例患者中（中位年龄78岁；56.4%为男性），334例（42.3%）的MUST评分≥2。77例患者（9.8%）发生SAI，其中HAP占46例（5.8%）。高MUST评分患者的SAI和HAP累积发生率均显著更高（Gray检验，两者P<0.001）。在多变量Fine-Gray竞争风险分析中，高MUST评分与SAI风险增加（校正SHR 5.46，95%CI 2.75-10.9）和HAP风险增加（校正SHR 5.63，95%CI 2.24-14.1）相关。在额外校正使用功能性经口摄入量表评估的基线吞咽状态后，这些关联显著减弱。探索性亚组分析提示，在轻度卒中患者中关联更强（美国国立卫生研究院卒中量表评分≤5；SAI的交互作用P=0.045，HAP的交互作用P=0.011）。
结论： 入院时MUST评分≥2与急性缺血性卒中患者SAI/HAP风险增加相关。
英文摘要
OBJECTIVE: Malnutrition is associated with adverse outcomes in patients with acute ischemic stroke, including increased risk of infections. The Malnutrition Universal Screening Tool (MUST) is widely used for nutritional risk assessment in patients with stroke. However, the association between the MUST score and stroke-associated infection remains unclear. This study aimed to investigate the association between a high MUST score (≥2) at admission and stroke-associated infection (SAI) in patients with acute ischemic stroke.
METHODS: We conducted a retrospective cohort study using a prospective stroke registry. Consecutive patients with acute ischemic stroke admitted between 2018 and 2020 were included. MUST score at admission was retrospectively assessed by registered dietitians. The primary outcome was SAI, including hospital-acquired pneumonia (HAP), and the secondary outcome was HAP. Association between high MUST score and outcomes was evaluated using Fine-Gray competing-risk regression models, treating in-hospital death and live discharge as competing events. Exploratory subgroup analysis according to age, sex, stroke severity, and dysphagia state was also performed.
RESULTS: Among 789 patients (median age, 78 years; 56.4% male), 334 (42.3%) had a MUST score ≥2. SAI occurred in 77 patients (9.8%), with HAP accounting for 46 (5.8%) of cases. Patients with a high MUST score had a significantly higher cumulative incidence of both SAI and HAP (Gray's test, both P < 0.001). In multivariable Fine-Gray competing-risk analyses, a high MUST score was associated with an increased risk of SAI (adjusted SHR 5.46, 95% CI 2.75-10.9) and HAP (adjusted SHR 5.63, 95% CI 2.24-14.1). These associations were substantially attenuated after additional adjustment for baseline swallowing status using the Functional Oral Intake Scale. Exploratory subgroup analyses suggested stronger associations among patients with mild stroke (National Institutes of Health Stroke Scale score ≤ 5; p for interaction = 0.045 in SAI and p for interaction = 0.011 in HAP) CONCLUSION: MUST score ≥2 at admission was associated with an increased risk of SAI/HAP in patients with acute ischemic stroke.