Introduction: Protein–energy malnutrition (PEM) may worsen outcomes after ischemic stroke. We evaluated whether PEM is associated with presentation severity and in-hospital outcomes among patients treated with endovascular thrombectomy (EVT). Methods: We conducted a retrospective cross-sectional analysis of the National Inpatient Sample (2015–2020). Exposure was a diagnosis of PEM at admission. Outcomes were length of stay (LOS), routine discharge, and in-hospital intracranial hemorrhage (ICH). Among EVT hospitalizations, survey-weighted linear and logistic regressions adjusted for stroke severity (NIHSS), demographics, vascular comorbidities, and hospital characteristics. Results: Of 2,755,905 ischemic stroke hospitalizations, 4.0% had PEM. EVT use was more frequent among PEM vs non-PEM hospitalizations (6.3% vs 4.5%). Within EVT hospitalizations, mean NIHSS was higher with PEM (17.5 vs 15.2; p<0.001). After adjustment, PEM was associated with longer LOS (β = 5.83 days; 95% CI, 4.77–6.88; p<0.001) and lower odds of routine discharge (OR = 0.31; 95% CI, 0.23–0.43; p<0.001). Crude ICH rates were higher with PEM (3.68% vs 2.31%), but adjusted odds were not significantly different (OR = 1.35; 95% CI, 0.89–2.06; p=0.16). Conclusions: In a nationally representative sample, PEM identified at admission was associated with greater stroke severity at presentation and worse in-hospital outcomes after EVT—specifically, substantially longer stays and lower likelihood of routine discharge—without higher adjusted odds of ICH. These findings support routine screening and early nutritional optimization in EVT care pathways.
Oak et al. (Thu,) studied this question.