Predictor Value of Total Protein Levels in the Very Acute Period of Ischemic Stroke. Secondary Analysis of a Prospective Observational Study

BACKGROUND: Acute cerebrovascular accident is the second most common cause of death in the world, with 450-480 thousand new cases of stroke reported annually in Russia, leading to disability and cognitive impairment. 37-78% of patients with ischemic stroke develop neurogenic dysphagia, which, combined with nutritional insufficiency (diagnosed in more than half of patients) significantly worsens the prognosis, complicating rehabilitation and increasing the risk of aspiration pneumonia and infectious complications. AIM: To study the predictor significance of total protein concentration in the acute period of AI. METHODS: Criteria for inclusion in the study: patients over 18 years of age with primary ischemic stroke (AI), confirmed by CT/MRI, and dysphagia in the acute period. Exclusion criteria included dysphagia of a different etiology, pregnancy, malignant neoplasms, severe cardiovascular, hepatic, renal pathologies, and acute infections. Diagnosis was performed using a comprehensive examination (CT angiography, laboratory tests, ECG, ECHO-KG) and assessment of neurological status (NIHSS), nutritional risk (NRS-2002), severity of dysphagia (MASA) and outcomes (GOS). RESULTS: Mortality in the study group was 19.1%, while ROC analysis revealed a threshold value of total protein on day 10 (59.3 g/l) as a significant predictor of outcome (AUC=0.860; p0.001). For atherothrombotic subtype II, the protein threshold is 59.3 g/l (AUC=0.887; p0.001), for cardioembolic — 60.5 g/l (AUC=0.771; p=0.03), both with a sensitivity of 100%. A decrease in total protein levels below the threshold values on day 10 is associated with an increase in mortality. CONCLUSION: A secondary analysis of the data from a prospective study of the effect of BEN on the results of AI treatment, complicated by the development of neurogenic dysphagia, revealed the prognostic value of total protein concentration in the acute period of AI. This is especially true for patients with AT-subtype II. The data obtained can be used in real clinical practice, however, additional randomized trials are needed to obtain more reliable results.