Transthyretin Concentrations in Acute Stroke Patients Predict Convalescent Rehabilitation.
OBJECTIVE
For stroke patients, intensive nutritional management is an important and effective component of inpatient rehabilitation. Accordingly, acute care hospitals must detect and prevent malnutrition at an early stage. Blood transthyretin levels are widely used as a nutritional monitoring index in critically ill patients. Here, we had analyzed the relationship between the transthyretin levels during the acute phase and Functional Independence Measure in stroke patients undergoing convalescent rehabilitation.


METHODS
We investigated 117 patients who were admitted to our hospital with acute ischemic or hemorrhagic stroke from February 2013 to October 2015 and subsequently transferred to convalescent hospitals after receiving acute treatment. Transthyretin concentrations were evaluated at 3 time points as follows: at admission, and 5 and 10 days after admission. After categorizing patients into 3 groups according to the minimum transthyretin level, we analyzed the association between transthyretin and Functional Independence Measure.


RESULTS
In our patients, transthyretin levels decreased during the first 5 days after admission and recovered slightly during the subsequent 5 days. Notably, Functional Independence Measure efficiency was significantly associated with the decrease in transthyretin levels during the 5 days after admission. Patients with lower transthyretin levels had poorer Functional Independence Measure outcomes and tended not to be discharged to their own homes.


CONCLUSIONS
A minimal transthyretin concentration (<10 mg/dL) is predictive of a poor outcome in stroke patients undergoing convalescent rehabilitation. In particular, an early decrease in transthyretin levels suggests restricted rehabilitation efficiency. Accordingly, transthyretin levels should be monitored in acute stroke patients to indicate mid-term rehabilitation prospects.
Department of Neurosurgery, Higashi-Sumiyoshi Morimoto Hospital, Osaka, Japan. Electronic address: neuisono@tachibana-med.or.jp.
Naofumi
N
Isono
Clinical Nutrition and Food Service, Higashi-Sumiyoshi Morimoto Hospital, Osaka, Japan.
Yuki
Y
Imamura
Clinical Nutrition and Food Service, Higashi-Sumiyoshi Morimoto Hospital, Osaka, Japan.
Keiko
K
Ohmura
Clinical Nutrition and Food Service, Higashi-Sumiyoshi Morimoto Hospital, Osaka, Japan; Clinical Nutrition and Food Service, Kokuho Central Hospital, Shiki, Japan.
Norihide
N
Ueda
Department of Neurosurgery, Osaka Medical College, Takatsuki, Japan.
Shinji
S
Kawabata
Department of Neurosurgery, Osaka Medical College, Takatsuki, Japan.
Motomasa
M
Furuse
Department of Neurosurgery, Osaka Medical College, Takatsuki, Japan.
Toshihiko
T
Kuroiwa
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D004185:Disability Evaluation; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D057187:Independent Living; D020300:Intracranial Hemorrhages / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D008297:Male; D015596:Nutrition Assessment; D009752:Nutritional Status; D010288:Parenteral Nutrition; D010351:Patient Discharge; D011228:Prealbumin / Q000378:metabolism*; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012189:Retrospective Studies; D020521:Stroke / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D011228:Prealbumin
Functional Independence Measure; National Institutes of Health Stroke Scale; Transthyretin; convalescent rehabilitation; efficiency; monitoring; outcome; stroke