Prognostic role of total protein concentration in hyperacute phase of ischemic stroke: results of secondary analysis of prospective study

BACKGROUND: Stroke ranks second among causes of mortality worldwide. In Russia, 450,000–480,000 new cases are reported annually, often resulting in disability and cognitive impairment. Neurogenic dysphagia develops in 37%–78% of patients with ischemic stroke (IS). This condition, especially when combined with malnutrition—diagnosed in more than half of patients—significantly worsens the prognosis, complicates rehabilitation, and increases the risk of aspiration pneumonia and other infectious complications. AIM: The work aimed to evaluate the prognostic value of total protein concentration in the hyperacute phase of ischemic stroke for clinical outcomes. METHODS: Inclusion criteria were patients aged 18 years and older with primary IS confirmed by computed tomography or magnetic resonance imaging and the presence of dysphagia in the acute phase. Exclusion criteria included dysphagia of another etiology, pregnancy, malignant neoplasms, severe cardiovascular, hepatic, or renal disorders, and acute infections. Diagnosis was based on a comprehensive assessment including CT angiography, laboratory testing, electrocardiography, and echocardiography. Neurological status was assessed using the NIHSS (National Institutes of Health Stroke Scale), nutritional risk using the NRS-2002 (Nutritional Risk Screening), dysphagia severity using the MASA (Mann Assessment of Swallowing Ability), and treatment outcomes using the GOS (Glasgow Outcome Scale). RESULTS: Mortality in the study group was 19.1%. ROC analysis demonstrated that the threshold value of total protein concentration on day 10 (59.3 g/L) was a significant predictor of mortality (AUC = 0.860; p 0.001). For the atherothrombotic subtype of IS, the threshold protein concentration was 59.3 g/L (AUC = 0.887; p 0.001), and 60.5 g/L (AUC = 0.771; p = 0.03) for the cardioembolic subtype. Both parameters demonstrated 100% sensitivity. A decrease in total protein concentration below these threshold values on day 10 was associated with increased mortality. CONCLUSION: Secondary analysis of data from a prospective study evaluating the impact of protein–energy deficiency on treatment outcomes in IS complicated by neurogenic dysphagia revealed the prognostic significance of total protein concentration in the hyperacute phase of IS. These findings are particularly relevant for patients with the atherothrombotic subtype of IS. The obtained results may be applied in clinical practice; however, further randomized studies are needed to confirm these conclusions.