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Ann Geriatr Med Res > Volume 28(4); 2024 > Article
Hori, Yoshimura, Wakabayashi, Nagano, Matsumoto, Shimazu, Shiraishi, Kido, Bise, Kuzuhara, Hamada, Yoneda, and Maekawa: Improved Systemic Inflammation is Associated with Functional Prognosis in Post-Stroke Patients

Abstract

Background

Systemic inflammation is associated with poor functional outcomes. However, the effects of improved inflammation on functional indicators remain unclear. This study aimed to clarify the relationship between improvements in systemic inflammation and activities of daily living in patients after stroke.

Methods

This retrospective cohort study included patients post stroke with systemic inflammation upon admission. Systemic inflammation was defined as a modified Glasgow Prognostic Score (mGPS) score of 1–2. Improvement in systemic inflammation was defined as a reduction in mGPS score or blood C-reactive protein (CRP) levels during hospitalization. The primary outcomes were the motor items of the Functional Independence Measure (FIM-motor) at discharge. We applied multiple linear regression analysis to examine whether reduced systemic inflammation was associated with outcomes after adjusting for confounding factors.

Results

Of the 1,490 patients recruited, 158 (median age of 79 years; 88 men) had systemic inflammation on admission and were included in the study. Among these patients, 131 (82.9%) and 147 (93.0%) exhibited reduced mGPS and CRP levels, respectively. The median change in CRP was 2.1 mg/dL (interquartile range, 1.1–3.8). Multivariate analysis revealed that improvements in mGPS (β=0.125, p=0.012) and CRP levels (β=0.108, p=0.108) were independently and positively associated with FIM-motor at discharge.

Conclusions

Improvement in systemic inflammation was positively associated with functional outcomes in patients post stroke. Early detection and therapeutic intervention for systemic inflammation may further improve outcomes in these patients.

INTRODUCTION

Systemic inflammation is negatively associated with patient outcomes.1) Inflammation occurs in response to infection, injury, or other stimuli, and triggers the release of inflammatory mediators throughout the body.2) These mediators can induce widespread inflammation, leading to organ dysfunction and failure.3) For instance, the activation of macrophages in the lungs can affect body function owing to systemic inflammation,4) whereas neuroinflammation can result in structural and functional brain damage.5,6) Patients who are critically ill commonly develop systemic inflammation, particularly those with sepsis or other infections. Moreover, systemic inflammation is linked to chronic inflammatory conditions including diabetes, obesity, and cardiovascular disease,7,8) is a significant predictor of mortality in patients with critical illness,9,10) and is associated with an unfavorable prognosis in individuals with chronic inflammatory diseases.2,11)
Reducing systemic inflammation may lead to favorable outcomes. Controlling systemic inflammation in combination with interventions to improve grip strength demonstrated significant benefits in activities of daily living (ADL) in older Chinese adults.12) Additionally, physical function, systemic inflammation, and dietary intake indicated associations in older adults receiving convalescent care.13) In patients with cachexia, the modified Glasgow Prognostic Score (mGPS) is associated with prognosis and is considered an indicator of systemic inflammation.14)
However, few studies have demonstrated an association between improvements in systemic inflammation and improvements in functional impairment. Therefore, this study aimed to clarify the relationship between improvements in systemic inflammation and ADL indicators in patients with systemic inflammation recovering from stroke events.

MATERIALS AND METHODS

Participants and Setting

This retrospective cohort study was conducted in a 225-bed rehabilitation hospital in Japan using an opt-out method that allowed patients to withdraw from the study at any time.

Convalescent Rehabilitation

Various specialists conducted convalescent rehabilitation programs, which lasted for up to 3 hours per day. The content was determined according to the functional abilities or disabilities of each patient and included physical, occupational, speech, and hearing therapies. These programs also included nutritional therapy,15) oral therapy,16) and medication management.17)

Eligible Patients

This study included patients recovering from stroke who also had systemic inflammation and were consecutively admitted to the Recovery Rehabilitation Unit of Kumamoto Rehabilitation Hospital between 2015 and 2022. We excluded the following patients: (1) those with impaired consciousness and (2) those who were unsuitable for bioelectrical impedance analysis (BIA) because of agitation, the presence of metals in the body, or the use of other medical devices.
We recorded patient information including age, sex, stroke type, history of stroke, mRS score before stroke onset,18) number of days between stroke onset and hospitalization, presence and stage of paralysis (Brunnstrom stage),19) and Charlson Comorbidity Index (CCI).20) Within 3 days of admission, physical function, cognitive function, and grip strength were assessed using the Functional Independence Measure (FIM).21)

Assessment of Systemic Inflammation

The presence of systemic inflammation was assessed using mGPS. This test is used to assess inflammation in patients with various cancers and inflammatory bowel disease.22,23) The mGPS score was calculated as follows: patients with high C-reactive protein (CRP; >1.0 mg/dL) and low albumin (<3.5 g/dL) were assigned a score of 2, those with high (>1.0 mg/dL) were assigned a score of 1, and patients with CRP ≤1.0 mg/dL were assigned a score of 0. Albumin levels did not affect scores of 1 or 0.24,25) We calculated the mGPS for all patients using data from admission to the rehabilitation unit. Systemic inflammation was defined as an mGPS of 1–2.
The mGPS was used to assess the presence of systemic inflammation; however, an improvement in mGPS was not necessarily defined as an improvement in inflammation as the mGPS also includes albumin and CRP levels. Thus, improved mGPS was defined as a decrease in mGPS at discharge compared with that at admission. In the acute phase, a decrease in CRP of 0.31 mg/dL is associated with a good prognosis in sepsis.26) Although no clear criteria exist regarding chronic inflammation in cardiovascular disease, an improvement in CRP levels may indicate a reduction in systemic inflammation.27) Using individual-level standard deviation (SD) estimates, the reported mean monthly SD of CRP level variation is 0.063 mg/dL, corresponding to a CRP risk threshold of 0.2 mg/dL.28) A change in CRP of approximately 0.2–0.3 mg/dL is likely to be due to inflammation. As even relatively small changes in CRP levels may occur due to inflammation, we defined an improvement in systemic inflammation as any decrease in CRP level at discharge from the hospital compared with the level at admission.

Outcomes

The primary outcome was the FIM-motor score, which is one of the most widely used tools for measuring ADL, at discharge. It is divided into 13 motor (FIM-motor) and five cognitive (FIM-cognitive) domain sub-items. Each ADL was rated on a seven-point ordinal scale ranging from fully assisted to fully independent, with total FIM, FIM-motor, and FIM cognitive scores ranges of 18–126, 13–91, and 5–35, respectively.
The secondary endpoint was the FIM-cognitive score at discharge.

Sample Size Calculation

Data from a previous study conducted under the same circumstances29) reported that patients' admission FIM-motor scores were normally distributed, with an SD of 23.4. We used these data to determine the sample size in the present study. In addition, inflammatory response in sepsis increased again in approximately 25% of patients after 3 months30); however, as patients in the convalescent ward are considered to be in a less inflammatory state, we expected approximately five times more patients in the improved inflammation group. To reject the null hypothesis with a power of 0.8 and an alpha error of 0.05, we calculated that a minimum of 19 patients would be required in the non-improved inflammation group if the true difference between the means of improved and unimproved systemic inflammation scores during hospitalization was 17, with a median frequency cutoff.31)

Statistical Analysis

We performed the statistical analyses using with IBM SPSS Statistics version 21.0 (IBM Corp., Armonk, NY, USA). As all continuous variables were nonparametric, medians (interquartile [IQR]) were reported. We used the χ2 and Mann–Whitney U tests to examine differences between groups according to the presence or absence of improvement in systemic inflammation and mGPS. Univariate and multivariate logistic analyses were used to examine the association of improvements in systemic inflammation and mGPS with FIM motor status after adjusting for confounders. We performed a multiple regression analysis to examine whether mGPS was independently associated with the discharge FIM-motor score as a functional outcome of rehabilitation medicine. The covariates selected to adjust for confounding variables were age,1,29,32,33) sex1,29,32) rehabilitation time,33) length of hospital stay,1,29,32) CCI,29) premorbid mRS,1,29) admission FIM-motor score,1,32) admission FIM-cognitive score,1,32) and admission mGPS score based on earlier studies and the clinical expertise of the co-authors of the present study. All patients were assessed for their ability to perform ADLs at the time of discharge. Statistical significance was set at p<0.05.

Ethical Considerations

This study was conducted in accordance with the tenets of the Declaration of Helsinki and was approved by the Ethics Committee of Kumamoto Rehabilitation Hospital (No. 232-230840). All patients were informed of the study and could withdraw at any time. Also, this study complied the ethical guidelines for authorship and publishing in the Annals of Geriatric Medicine and Research.34)

RESULTS

Of the 1,490 patients who recovered from stroke and were consecutively hospitalized during the study period, 128 who were deemed ineligible for BIA, 48 with a severely impaired level of consciousness (as judged by the three-digit Japan Coma Scale), and 401 with missing data were excluded from this analysis. Finally, this study included 158 patients (median age, 80 years; 88 males and 70 females) with systemic inflammation (Fig. 1).
The patient characteristics are presented in Table 1. The stroke types included cerebral infarction (n=105, 66.5%), cerebral hemorrhage (n=43, 27.2%), and subarachnoid hemorrhage (n=10, 6.3%). The median patient age was 80 years (IQR, 70–85), and 55.7% were male. Patients with a history of stroke accounted for 31.6% of the study population, with a median premorbid mRS score of 0 (IQR, 0–2) and a median CCI of 3 (IQR, 3–4). The median baseline FIM scores were 35 (IQR, 21–60), 20 (IQR, 12–43), and 13 (IQR, 7–20), respectively. Of the 158 subjects, 131 (82.9%) demonstrated an improvement in mGPS, and 147 (93.0%) indicated an improvement in CRP. The median change in CRP was 2.1 mg/dL (IQR, 1.1–3.8).
Tables 2 and 3 outline the results of univariate analyses assessing the associations of improvements in mGPS and CRP levels with discharge FIM motor and cognitive scores, respectively. Improvements in mGPS were significantly associated with discharge FIM motor scores (62 [IQR, 29–84] vs. 24 [IQR, 13–42]; p<0.001) and cognitive scores (24 [IQR, 16–30] vs. 17 [IQR, 11–21]; p<0.001). Similarly, improvements in CRP levels were significantly associated with FIM motor (59 [IQR, 24–82] vs. 24 [IQR, 15–34]; p=0.016) and cognitive (23 [IQR, 16–29] vs. 13 [IQR, 12–19]; p=0.015) functions at discharge.
Tables 4 and 5 present the multivariate analyses assessing the associations of improvements in mGPS and CRP levels with discharge FIM-motor and FIM-cognitive scores, respectively. Improvements in mGPS were independently associated with FIM-motor (β=0.125, p=0.013) but not with FIM-cognitive (β=0.088, p=0.069) at discharge, while improvements in CRP levels were independently associated with both FIM-motor (β=0.108, p=0.028) and FIM-cognitive (β=0.099, p=0.035) at discharge.

DISCUSSION

We investigated the association between improvements in systemic inflammation and functional outcomes in patients undergoing convalescent rehabilitation after stroke. Our results revealed two novel findings: (1) improvements in systemic inflammation and reductions in mGPS were positively associated with ADL recovery, and (2) improvements in systemic inflammation were positively associated with cognitive recovery, whereas reductions in mGPS were not.
In the present study, improvements in systemic inflammation and reductions in mGPS were positively associated with ADL recovery in patients with systemic inflammation recovering from stroke. Our findings highlight the importance of addressing systemic inflammation to improve the functional and cognitive outcomes in these patients. Systemic inflammation adversely affects life and functional prognosis in several diseases; however, amelioration of inflammation may improve prognosis.1,2,9,11) The results of the present study suggest that the effects of systemic inflammation are reversible in some patients. Rehabilitation and nutrition are important for functional improvement. Anti-inflammatory interventions should be considered in patients with systemic inflammation.35-37)
In our patient cohort, improvements in systemic inflammation were positively associated with cognitive recovery, whereas reductions in mGPS did not show a significant association. Systemic inflammation affects cognitive function and may contribute to cognitive decline and dementia.38,39) The markers of inflammation are also associated with rates of cognitive decline.40,41) In Alzheimer's disease, systemic inflammation may exacerbate neuroinflammation. Thus, the association between systemic inflammation and neuroinflammation may explain the association between systemic inflammation and cognitive function.29) Improvements in mGPS were not significantly related to cognitive function in this study, although further evaluation using different sample sizes is warranted to definitively determine whether a significant relationship exists.
Exercise and diet are important for improving systemic inflammation. Moderate physical activity and exercise exert anti-inflammatory effects and prevent chronic inflammation-related diseases.31,34,36) Nutrient content indicative of anti-inflammation, such as ω3 fatty acid levels, have also demonstrated similar effects.37) The results of the present study suggest that improving inflammation is directly related to ADL and that comprehensive interventions such as exercise and nutrition therapies are needed to improve outcomes by reducing systemic inflammation.
This study has several limitations. First, we conducted this study in a single hospital in Japan and limited the study population to patients with systemic inflammation upon admission, which reduced the number of patients included in the analysis and may have limited the generalizability of our results. Moreover, the sample size was adequate for mGPS but was insufficient for CRP. Further multicenter studies are required to verify whether similar results can be obtained in different populations. Second, we were unable to evaluate the factors that contributed to the change in inflammation. Therefore, future studies should evaluate the association between rehabilitation therapies such as aerobic exercise and resistance training, and nutritional therapies such as ω3 fatty acid and branched-chain amino acid (BCAA) intake, and reductions in inflammation. Third, we did not assess the causes of inflammation in our patients; thus, we could not determine whether the reduced inflammation differed depending on the underlying cause.
In conclusion, improvement in systemic inflammation may be positively correlated with functional outcomes in patients post stroke with systemic inflammation. In the presence of systemic inflammation, inflammation control should be targeted as improved systemic inflammation may be directly related to functional outcomes.

ACKNOWLEDGMENTS

CONFLICT OF INTEREST

The researchers claim no conflicts of interest.

FUNDING

None.

AUTHOR CONTRIBUTIONS

Conceptualization, KH, YY, HW, FN, AM, SS, AS, YK, TB, AK, TH, KY, KM; Investigation and methodology, KH, YY, HW, FN, AM, SS, AS, YK, TB, AK, TH, KY, KM; Data curation, KH, YY, HW, FN, AM, SS, AS, YK, TB, AK, TH, KY, KM; Writing–original draft, KH, YY, HW, FN, AM, SS, AS, YK, TB, AK, TH, KY, KM.

Fig. 1.
Flowchart of participant screening, and inclusion criteria. BIA, bioelectrical impedance analysis.
agmr-24-0020f1.jpg
Table 1.
Baseline characteristics of participants (n=158)
Characteristic Value
Age (y) 80 (70–85)
Sex, male 88 (55.7)
Stroke type
 Cerebral infarction 105 (66.5)
 Cerebral hemorrhage 43 (27.2)
 Subarachnoid hemorrhage 10 (6.3)
Stroke history 50 (31.6)
Premorbid mRS 0 (0–2)
Onset-admission days 15 (11–22)
Paralysis
 Right 68 (43.0)
 Left 66 (41.8)
BRS
 Upper limb 3 (2–5)
 Hand-finger 4 (1–5)
 Lower limb 4 (2–5)
CCI 3 (3–4)
Rehabilitation (units/day) 8.15 (6.91–8.52)
Length of stay (day) 117 (82–148)
FIM score
 Total 35 (21–60)
 Motor 20 (13–43)
 Cognitive 13 (7–20)
Grip strength (kg) 12.5 (0–21.7)
Albumin (g/dL) 3.1 (2.8–3.5)
Systemic inflammation at baseline
 mGPS score 2 110 (69.6)
 mGPS score 1 48 (30.4)
 CRP (mg/dL) 2.5 (1.6–4.9)
Improvement in systemic inflammation
 Improvement of mGPS 131 (82.9)
 Improvement of CRP 147 (93.0)
 CRP change (mg/dL) 2.1 (1.1–3.8)

Values are presented as median (interquartile range) or number (%).

mRS, modified Rankin Scale; CCI, Charlson comorbidity index; FIM, Functional Independence Measure; mGPS, modified Glasgow Prognostic Score; CRP, C-reactive protein.

Rehabilitation (included physical and occupational, speech and swallowing therapy) performed during hospitalization (1 unit = 20 min).

CRP change was defined as CRP at admission minus CRP at discharge.

Comparisons between the two groups were made, depending on the type of variable data, Mann-Whitney U tests (two independent variables that were not normally distributed), and chi-square tests (nominal variables).

Table 2.
Univariate analysis of FIM-motor at discharge and FIM-cognitive at discharge with and without improvement of mGPS
Total (n=158) Non-mGPS improved group (n=27) mGPS improved group (n=131) p-value
FIM-motor at discharge 54 (22–82) 24 (13–42) 62 (29–84) <0.001
FIM-cognitive at discharge 22 (15–29) 17 (11–21) 24 (16–30) <0.001

Values are presented as median (interquartile range)

FIM, Functional Independence Measure; mGPS, modified Glasgow Prognostic Score.

Comparisons between the two groups were made using Mann-Whitney U tests.

Table 3.
Univariate analysis of FIM-motor at discharge and FIM-cognitive at discharge with and without improvement of CRP
Total (n=158) Non-CRP improved group (n=11) CRP improved group (n=147) p-value
FIM-motor at discharge 54 (22–82) 24 (15–34) 59 (24–82) 0.016
FIM-cognitive at discharge 22 (15–29) 13 (12–19) 23 (16–29) 0.015

Values are presented as median (interquartile range)

FIM, Functional Independence Measure; CRP, C-reactive protein.

Comparisons between the two groups were made using Mann-Whitney U tests.

Table 4.
Multiple regression analysis of FIM-motor at discharge and FIM-cognitive at discharge with and without improvement of mGPS
FIM-motor at discharge
FIM-cognitive at discharge
β B (95% CI) p-value β B (95% CI) p-value
Age -0.099 -0.251 (-0.544–0.042) 0.093 -0.076 -0.061 (-0.151–0.030) 0.188
Sex, male -0.053 -3.034 (-8.631–2.544) 0.284 -0.068 -1.240 (-2.969–0.489) 0.162
Rehabilitationa) 0.080 1.900 (-0.654–4.455) 0.144 0.091 0.679 (-0.111–1.470) 0.092
Length of stay 0.071 0.050 (-0.031–0.130) 0.223 0.184 0.041 (0.016–0.066) 0.001
CCI -0.091 -1.687 (-3.408–0.034) 0.055 -0.090 -0.524 (-1.056–0.009) 0.054
Premorbid mRS -0.080 -1.552 (-3.676–0.572) 0.151 -0.001 -0.005 (-0.662–0.653) 0.989
FIM-motor on admission 0.556 0.821 (0.598–1.043) <0.001 0.179 0.084 (0.015–0.152) 0.018
FIM-cognitive on admission 0.129 0.471 (-0.027–0.970) 0.064 0.600 0.695 (0.541–0.850) <0.001
mGPS on admission -0.112 -7.034 (-13.809–-0.260) 0.042 -0.081 -1.605 (-3.701–0.492) 0.133
Improvement of mGPSb) 0.125 9.559 (2.139–16.980) 0.012 0.089 2.153 (-0.143–4.450) 0.066

FIM, Functional Independence Measure; mGPS, modified Glasgow Prognostic Score; CCI, Charlson Comorbidity Index; mRS, modified Rankin Scale.

a)Rehabilitation (included physical and occupational, speech and swallowing therapy) performed during hospitalization (1 unit=20 min).

b)Improvement of mGPS is a binary variable (improvement of mGPS is defined as a decrease in mGPS at discharge compared to mGPS at admission, and all others are defined as no improvement).

Table 5.
Multiple regression analysis of FIM-motor at discharge and FIM-cognitive at discharge with and without improvement of CRP
FIM-motor at discharge
FIM-cognitive at discharge
β B (95% CI) p-value β B (95% CI) p-value
Age -0.126 -0.319 (-0.611–-0.027) 0.032 -0.094 -0.075 (-0.164–0.013) 0.095
Sex, male -0.039 -2.233 (-7.860–3.393) 0.434 -0.054 -0.998 (-2.701–0.706) 0.249
Rehabilitationa) 0.087 2.058 (-0.570–4.686) 0.124 0.104 0.778 (-0.018–1.573) 0.055
Length of stay 0.090 0.063 (-0.019–0.146) 0.124 0.211 0.047 (0.022–0.072) <0.001
CCI -0.077 -1.427 (-3.180–0.326) 0.110 -0.075 -0.435 (-0.966–0.096) 0.107
Premorbid mRS -0.091 -1.780 (-3.924–0.364) 0.103 -0.004 -0.023 (-0.672–0.627) 0.945
FIM-motor on admission 0.613 0.904 (0.685–1.122) <0.001 0.230 0.108 (0.041–0.174) 0.002
FIM-cognitive on admission 0.137 0.501 (-0.003–1.005) 0.052 0.604 0.700 (0.547–0.852) <0.001
CPR on admission -0.001 -0.011(-0.811–0.789) 0.978 0.059 0.154 (-0.088–0.396) 0.211
Improvement of CPRb) 0.118 13.404 (2.639–24.169) 0.015 0.101 3.629 (0.370–6.888) 0.029

FIM, Functional Independence Measure; CPR, C-reactive protein; CCI, Charlson Comorbidity Index; mRS, modified Rankin Scale; CI, confidence interval.

a)Rehabilitation (included physical and occupational, speech and swallowing therapy) performed during hospitalization (1 unit=20 min).

b)Improvement of CPR is a binary variable (improvement of CPR is defined as a decrease in CPR at discharge compared to CPR at admission, and all others are defined as no improvement).

REFERENCES

1. Yoshimura Y, Bise T, Nagano F, Shimazu S, Shiraishi A, Yamaga M, et al. Systemic Inflammation in the Recovery Stage of Stroke: Its Association with Sarcopenia and Poor Functional Rehabilitation Outcomes. Prog Rehabil Med 2018;3:20180011.
crossref pmid pmc
2. Furman D, Campisi J, Verdin E, Carrera-Bastos P, Targ S, Franceschi C, et al. Chronic inflammation in the etiology of disease across the life span. Nat Med 2019;25:1822-32.
crossref pmid pmc pdf
3. Bhatia M, Moochhala S. Role of inflammatory mediators in the pathophysiology of acute respiratory distress syndrome. J Pathol 2004;202:145-56.
crossref pmid
4. Baines KJ, Backer V, Gibson PG, Powel H, Porsbjerg CM. Impaired lung function is associated with systemic inflammation and macrophage activation. Eur Respir J 2015;45:557-9.
crossref pmid
5. Lin T, Liu GA, Perez E, Rainer RD, Febo M, Cruz-Almeida Y, et al. Systemic inflammation mediates age-related cognitive deficits. Front Aging Neurosci 2018;10:236.
crossref pmid pmc
6. Kwak MJ. Delirium in frail older adults. Ann Geriatr Med Res 2021;25:150-9.
crossref pmid pmc pdf
7. Chakraborty RK, Burns B. Systemic inflammatory response syndrome [Internet]. Treasure Island, FL: StatPearls Publishing; 2023 [cited 2023 Dec 4]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK547669/.

8. Khafagy R, Dash S. Obesity and cardiovascular disease: the emerging role of inflammation. Front Cardiovasc Med 2021;8:768119.
crossref pmid pmc
9. Jentzer JC, Lawler PR, van Diepen S, Henry TD, Menon V, Baran DA, et al. Systemic inflammatory response syndrome is associated with increased mortality across the spectrum of shock severity in cardiac intensive care patients. Circ Cardiovasc Qual Outcomes 2020;13:e006956.
crossref pmid
10. Cox CE. Persistent systemic inflammation in chronic critical illness. Respir Care 2012;57:859-66.
crossref pmid
11. Cervellati C, Trentini A, Bosi C, Valacchi G, Morieri ML, Zurlo A, et al. Low-grade systemic inflammation is associated with functional disability in elderly people affected by dementia. Geroscience 2018;40:61-9.
crossref pmid pmc pdf
12. Qin K, Lin L, Lu C, Chen W, Guo VY. Association between systemic inflammation and activities of daily living disability among Chinese elderly individuals: the mediating role of handgrip strength. Aging Clin Exp Res 2022;34:767-74.
crossref pmid pdf
13. Dennis RA, Johnson LE, Roberson PK, Heif M, Bopp MM, Garner KK, et al. Changes in activities of daily living, nutrient intake, and systemic inflammation in elderly adults receiving recuperative care. J Am Geriatr Soc 2012;60:2246-53.
crossref pmid pdf
14. Proctor MJ, Morrison DS, Talwar D, Balmer SM, O’Reilly DS, Foulis AK, et al. An inflammation-based prognostic score (mGPS) predicts cancer survival independent of tumour site: a Glasgow Inflammation Outcome Study. Br J Cancer 2011;104:726-34.
crossref pmid pmc pdf
15. Shimazu S, Yoshimura Y, Kudo M, Nagano F, Bise T, Shiraishi A, et al. Frequent and personalized nutritional support leads to improved nutritional status, activities of daily living, and dysphagia after stroke. Nutrition 2021;83:111091.
crossref pmid
16. Yoshimura Y, Shiraishi A, Tsuji Y, Momosaki R. Oral management and the role of dental hygienists in convalescent rehabilitation. Prog Rehabil Med 2022;7:20220019.
crossref pmid pmc
17. Yoshimura Y, Matsumoto A, Momosaki R. Pharmacotherapy and the role of pharmacists in rehabilitation medicine. Prog Rehabil Med 2022;7:20220025.
crossref pmid pmc
18. Banks JL, Marotta CA. Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke 2007;38:1091-6.
crossref pmid
19. Brunnstrom S. Motor testing procedures in hemiplegia: based on sequential recovery stages. Phys Ther 1966;46:357-75.
crossref pmid
20. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-83.
crossref pmid
21. Ottenbacher KJ, Hsu Y, Granger CV, Fiedler RC. The reliability of the functional independence measure: a quantitative review. Arch Phys Med Rehabil 1996;77:1226-32.
crossref pmid
22. McMillan DC. The systemic inflammation-based Glasgow Prognostic Score: a decade of experience in patients with cancer. Cancer Treat Rev 2013;39:534-40.
crossref pmid
23. Zhao C, Ding C, Xie T, Zhang T, Dai X, Wei Y, et al. Validation and optimization of the Systemic Inflammation-Based modified Glasgow Prognostic Score in predicting postoperative outcome of inflammatory bowel disease: preliminary data. Sci Rep 2018;8:747.
crossref pmid pmc pdf
24. McMillan DC. An inflammation-based prognostic score and its role in the nutrition-based management of patients with cancer. Proc Nutr Soc 2008;67:257-62.
crossref pmid
25. Ishihara H, Kondo T, Omae K, Takagi T, Iizuka J, Kobayashi H, et al. Sarcopenia and the modified Glasgow Prognostic Score are significant predictors of survival among patients with metastatic renal cell carcinoma who are receiving first-line sunitinib treatment. Target Oncol 2016;11:605-17.
crossref pmid pdf
26. Coelho L, Povoa P, Almeida E, Fernandes A, Mealha R, Moreira P, et al. Usefulness of C-reactive protein in monitoring the severe community-acquired pneumonia clinical course. Crit Care 2007;11:R92.
crossref pmid pmc pdf
27. Xie S, Galimberti F, Olmastroni E, Luscher TF, Carugo S, Catapano AL, et al. Effect of lipid-lowering therapies on C-reactive protein levels: a comprehensive meta-analysis of randomized controlled trials. Cardiovasc Res 2024;120:333-44.
crossref pmid pmc pdf
28. Bogaty P, Dagenais GR, Joseph L, Boyer L, Leblanc A, Belisle P, et al. Time variability of C-reactive protein: implications for clinical risk stratification. PLoS One 2013;8:e60759.
crossref pmid pmc
29. Yoshimura Y, Wakabayashi H, Nagano F, Matsumoto A, Shimazu S, Shiraishi A, et al. Phase angle is associated with sarcopenic obesity in post-stroke patients. Clin Nutr 2023;42:2051-7.
crossref pmid
30. Yende S, Kellum JA, Talisa VB, Peck Palmer OM, Chang CH, Filbin MR, et al. Long-term host immune response trajectories among hospitalized patients with sepsis. JAMA Netw Open 2019;2:e198686.
crossref pmid pmc
31. Beninato M, Gill-Body KM, Salles S, Stark PC, Black-Schaffer RM, Stein J. Determination of the minimal clinically important difference in the FIM instrument in patients with stroke. Arch Phys Med Rehabil 2006;87:32-9.
crossref pmid
32. Shimogai T, Izawa KP, Kawada M, Kuriyama A. Factors affecting discharge to home of medical patients treated in an intensive care unit. Int J Environ Res Public Health 2019;16:4324.
crossref pmid pmc
33. Kwakkel G, van Peppen R, Wagenaar RC, Wood Dauphinee S, Richards C, Ashburn A, et al. Effects of augmented exercise therapy time after stroke: a meta-analysis. Stroke 2004;35:2529-39.
crossref pmid
34. Shin JC, Cho KH, Han EY, Ahn KH, Im SH. Impact of rehabilitation nutrition and healthy weight maintenance in motor-complete tetraplegia patients. J Clin Med 2022;11:4970.
crossref pmid pmc
35. Noh JH, Jung HW, Ga H, Lim JY. Ethical guidelines for publishing in the Annals of Geriatric Medicine and Research. Ann Geriatr Med Res 2022;26:1-3.
crossref pmid pmc pdf
36. Ito Y, Wakabayashi H, Nishioka S, Nomura S, Momosaki R. Impact of rehabilitation dose on nutritional status at discharge from a convalescent rehabilitation ward in malnourished patients with hip fracture. Healthcare (Basel) 2021;9:722.
crossref pmid pmc
37. Kou K, Momosaki R, Miyazaki S, Wakabayashi H, Shamoto H. Impact of nutrition therapy and rehabilitation on acute and critical illness: a systematic review. J UOEH 2019;41:303-15.
crossref pmid
38. Holmes C, Cunningham C, Zotova E, Woolford J, Dean C, Kerr S, et al. Systemic inflammation and disease progression in Alzheimer disease. Neurology 2009;73:768-74.
crossref pmid pmc
39. Walker KA, Gottesman RF, Wu A, Knopman DS, Gross AL, Mosley TH Jr, et al. Systemic inflammation during midlife and cognitive change over 20 years: the ARIC Study. Neurology 2019;92:e1256-67.
crossref pmid pmc
40. Trollor JN, Smith E, Agars E, Kuan SA, Baune BT, Campbell L, et al. The association between systemic inflammation and cognitive performance in the elderly: the Sydney Memory and Ageing Study. Age (Dordr) 2012;34:1295-308.
crossref pmid pdf
41. Beydoun MA, Dore GA, Canas JA, Liang H, Beydoun HA, Evans MK, et al. Systemic inflammation is associated with longitudinal changes in cognitive performance among urban adults. Front Aging Neurosci 2018;10:313.
crossref pmid pmc


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