Nutrition program selection in acute ischemic stroke patients with GI hemorrhage.

Background And Objectives: The severity of neurologic impairment is significantly associated with gastrointestinal (GI) hemorrhage. Therefore, the aim of this study was to compare the effect of two nutritional interventions in acute ischemic stroke patients with GI hemorrhage.

Methods And Study Design: We retrospectively studied consecutive ischemic stroke patients with GI hemorrhage from January 2014 to December 2018. They were stratified into two programs of nutritional therapy after GI hemorrhage: moderate feeding (more than 70% optimal caloric uptake, 50-100 mL/h) and trophic feeding (16-25% of the target energy expenditure, 25 kcal/kg per day, 10- 30 mL/h) with supplemental parenteral nutrition.

Results: The group receiving moderate feeding included 30 patients, and the group receiving trophic feeding and supplemental parenteral nutrition included 32 patients. There was no statistically significant difference between the two groups in the baseline characteristics of the patients. Mortality, Glasgow Coma Scale (GCS) score at discharge, and Glasgow Outcome Scale (GOS) score 3 months after discharge were compared between the two groups. In the moderate feeding group, the overall mortality was significantly lower than in the trophic feeding and supplemental parenteral nutrition group (p<0.05). Conscious state and neurological severity were assessed by the GCS score before discharge, and the score was higher in the moderate feeding group than in the other group (p<0.05). The GOS score 3 months after discharge was higher in the moderate feeding group than in the trophic feeding and supplemental parenteral nutrition group (p<0.05). These three items showed that moderate feeding led to a better prognosis: lower occurrence of mortality, higher GCS score at discharge, and higher GOS score 3 months after discharge.

Conclusions: This study showed that moderate feeding had a much more profound effect on the outcomes than trophic feeding and supplemental parenteral nutrition, as it was associated with lower mortality, higher GCS score at discharge, and higher GOS score 3 months after discharge.