Association of nutritional indices and prognosis of stroke patients: a systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to document the association between malnutrition and mortality as well as functional outcomes in patients with stroke. MATERIALS AND METHODS: PubMed, Embase and Scopus databases were systematically searched for observational studies that had used either of the three nutritional indices, geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), and controlling nutritional status score (CONUT), and examined the association between malnutrition and outcomes of interest in patients with stroke. The primary outcome was mortality and secondary outcomes were risk of recurrence and functional disability. Analysis was performed using STATA 16.0 software (College Station, TX, USA) and pooled effect sizes were reported as either hazards ratio (HR) or as odds ratio (OR). Random effects model was used for the analysis. RESULTS: A total of 20 studies were included, of which, 15 were focused on acute ischemic stroke (AIS) patients. Among patients with AIS, moderate to severe malnutrition, assessed using CONUT (OR 4.80, 95% CI: 2.31, 9.98), GNRI (OR 3.57, 95% CI: 2.08, 6.12) and PNI (OR 8.10, 95% CI: 4.69, 14.0), was associated with increased risk of mortality within 3 months and at 1-year follow-up (CONUT: OR 2.74, 95% CI: 1.96, 3.83; GNRI: OR 2.26, 95% CI: 1.34, 3.81; PNI: OR 3.32, 95% CI: 2.24, 4.93). Patients with moderate to severe malnutrition, assessed using any of the three indices, had an increased risk of having an unfavourable outcome [modified Rankin Score (mRS) score of 3 to 6, denoting major disability and/or death] within 3 months and at 1-year follow-up. Only one study reported the risk of recurrence. CONCLUSIONS: Assessing malnutrition in stroke patients at the time of hospital admission using any of the three nutritional indices is useful due to the observed association of malnutrition with survival and functional outcomes. However, due to a limited number of studies, there is a need for large prospective studies to validate the findings observed in this meta-analysis.

Stereochemistry of the major rat liver microsomal metabolites of the carcinogen 7-methylbenz[c]acridine.

The major metabolites of the carcinogen 7-methylbenz[c]acridine (7MBAC), trans-5,6-dihydro-5,6-dihydroxy-7-methylbenz[c]acridine (7MBAC-5,6-DHD), and trans-8,9-dihydro-8,9-dihydroxy-7-methylbenz[c]acridine (7MBAC-8,9-DHD) were characterized as their enantiomers after separation of their bis-(+)-(1R,2S,4S)-endo-1,4,5,6,7,7-hexachlorobicyclo[2.2.1]hept-5 -ene-2-carboxylic acid [(+)-HCA] esters and hydrolysis. The synthetic precursor, trans-3,4-dihydroxy-7-methyl-1,2,3,4-tetrahydrobenz[c]acridine (7MBAC-3,4-THD), was similarly separated into enantiomers, and the dihydrodiol trans-3(S),4(S)-dihydro-3,4-dihydroxy-7-methylbenz[c]acridine (7MBAC-3,4-DHD) was prepared from 7MBAC-3(S),4(S)-THD. Absolute configurations were assigned by the chiral exciton coupling of the bis-p-(dimethylamino)benzoate of 7MBAC-3(R),4(R)-THD, and by the semiempirical methods based on the biaryl chromophores of the enantiomers of 7MBAC-5,6-DHD and of the methanolysis products of the 5,6-oxide of 7MBAC which were resolved as their (+)-HCA esters. X-ray crystallography was used for 7MBAC-8(S),9(S)-DHD bis-(+)-HCA ester, and assignments were correlated with chiral exciton coupling of the bis-4-(dimethylamino)cinnamates of 7MBAC-5(R),6(R)-DHD and 7MBAC-8(S),9(S)-DHD. The stereochemical compositions of four metabolites (three dihydrodiols and 7MBAC-5,6-oxide) formed in incubations with rat liver microsomes from control and induced liver were determined by normal-phase separations of bis-(+)-HCA esters, and by chiral stationary-phase separation of the 5,6-oxide methanolysis products. The 3(R),4(R)-enantiomer of 7MBAC-3,4-dihydrodiol predominated, 74-98% enantiomeric purity, and purity for the oxide varied from about 71% 5(R),6(S)-oxide for control microsomes to about 28% 5(R),6(S)-oxide for liver microsomes obtained from 3-methylcholanthrene-pretreated rats.