Association of body water balance, nutritional risk, and sarcopenia with outcome in patients with acute ischemic stroke

Background Bioelectrical impedance analysis (BIA) can serve to evaluate body water balance and muscle mass. The present study aimed to explore the interrelationships among body water balance, nutritional risk, sarcopenia, and outcome after acute ischemic stroke (AIS). Methods This single-center, prospective study included 111 patients with AIS and a premorbid modified Rankin Scale score (mRS) ≤2. Overhydration, indicating a body water balance abnormality, was defined as an extracellular fluid/total body water ratio >0.390. The geriatric nutritional risk index (GNRI) was used as nutrition marker, a GNRI <92 was considered low. Sarcopenia was defined according to the 2019 Asian Working Group for Sarcopenia criteria. Poor outcome was defined as an mRS ≥3 at discharge. Results In the overall cohort, including 40 women, the median age was 77 years, 43 had poor prognosis, 31 overhydration, 25 low GNRI, and 44 sarcopenia. Patients with poor outcome had significantly higher National Institutes of Health Stroke Scale (NIHSS) scores, and significantly more common with overhydration, low GNRI, and sarcopenia (P <0.001 for all). Increasing concomitance of overhydration, low GNRI, and sarcopenia was associated with a heightened rate of poor outcomes. Especially, poor outcome was observed in 19 of 23 patients with low muscle mass and overhydration. In multivariate analysis, overhydration (odds ratio [OR] 5.504, 95% confidence interval [CI] 1.717–17.648; P = 0.004), age (OR 1.062, 95%CI 1.010–1.117; P = 0.020) and NIHSS score (OR 1.790, 95%CI 1.307–2.451; P < 0.001) were independent poor prognostic factors. Conclusions Body water balance and muscle mass assessment using BIA was useful in predicting AIS outcome. Overhydration was particularly associated with poor outcome. The combination of overhydration and low muscle mass could specifically predict poor outcomes after AIS. ![Figure][1] ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial This study is not an intervention study and is not enrolled in a registry. ### Funding Statement This study was supported by JSPS KAKENHI (grant no. JP 21K17692). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the Institutional Research Review Board of Nihon University (approval no: RK-210713-6). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data that support the findings of this study are available from the corresponding author upon reasonable request. * AIS : acute ischemic stroke BIA : bioelectrical impedance analysis BCM : body cell mass ECF : extracellular fluid ECS : extracellular solids ECW : extracellular water GNRI : geriatric nutritional risk index GLIM : Global Leadership Initiative on Malnutrition IBW : ideal body weight ICW : intracellular water TBW : total body water [1]: pending:yes