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Key summary points Aim <p>To examine whether the coexistence of elevated extracellular water–to–total body water ratio (ECW/TBW) and low appendicular lean soft tissue index (ALSTI), a combined fluid-muscle phenotype, predicted poorer functional independence at hospital discharge.</p> Findings <p>The coexistence of high ECW/TBW and low ALSTI was associated with poorer functional independence at hospital discharge, whereas low ALSTI alone was not.</p> Message <p>The interpretation of ALSTI in patients with acute stroke should consider ECW/TBW and that ALSTI with ECW/TBW is clinically useful in predicting prognosis.</p> Abstract Purpose <p>We aimed to examine whether the coexistence of elevated extracellular water–to–total body water ratio (ECW/TBW) and low appendicular lean soft tissue index (ALSTI), a combined fluid-muscle phenotype, predicted poorer functional independence at hospital discharge.</p> Methods <p>Patients aged ≥65 years with an acute stroke between 2021 and 2024 were included. Baseline body composition was measured using bioelectrical impedance analysis within one week of rehabilitation initiation. High ECW/TBW was defined as ≥0.400, and low ALSTI as &lt;7.0 kg/m<sup>2</sup> for males and &lt;5.7 kg/m<sup>2</sup> for females. Functional independence at discharge was assessed using the modified Rankin Scale (mRS), with scores of 0–2 defined as independent and 3–6 defined as non-independent. Multivariate logistic regression analysis was used to examine the effects of the coexistence of high ECW/TBW and low ALSTI on functional independence.</p> Results <p>In total, 560 patients were included in the analysis. The number of patients with high ECW/TBW and low ALSTI was 227 (49.4%). Multivariate logistic regression analysis showed that the coexistence of high ECW/TBW and low ALSTI at baseline was a significant associated with non-independence at discharge (odds ratio (OR) = 3.82, 95% confidence interval (CI) 2.00–7.32, P &lt; 0.001), but low ALSTI alone was not (OR = 1.73, 95% CI 0.92–3.22, P = 0.086).</p> Conclusions <p>Baseline coexistence of high ECW/TBW and low ALSTI, highlighting the importance of considering fluid imbalance in addition to muscle mass, was associated with for non-independence at hospital discharge in patients with acute stroke.</p>

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Muscle loss must be interpreted in the context of fluid imbalance: a dual-parameter model predicts functional outcomes after acute stroke

  • 期刊论文

  • 发表日期：

    2026年4月5日

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  • Kota Amakasu,
  • Tatsuro Inoue,
  • Araki Saito,
  • Natsumi Kamada,
  • Akiko Brown,
  • Akari Kasai,
  • Mei Furusawa,
  • Sota Kobayashi,
  • Yumiko Watanabe

摘要

Key summary points Aim

To examine whether the coexistence of elevated extracellular water–to–total body water ratio (ECW/TBW) and low appendicular lean soft tissue index (ALSTI), a combined fluid-muscle phenotype, predicted poorer functional independence at hospital discharge.

Findings

The coexistence of high ECW/TBW and low ALSTI was associated with poorer functional independence at hospital discharge, whereas low ALSTI alone was not.

Message

The interpretation of ALSTI in patients with acute stroke should consider ECW/TBW and that ALSTI with ECW/TBW is clinically useful in predicting prognosis.

Abstract Purpose

We aimed to examine whether the coexistence of elevated extracellular water–to–total body water ratio (ECW/TBW) and low appendicular lean soft tissue index (ALSTI), a combined fluid-muscle phenotype, predicted poorer functional independence at hospital discharge.

Methods

Patients aged ≥65 years with an acute stroke between 2021 and 2024 were included. Baseline body composition was measured using bioelectrical impedance analysis within one week of rehabilitation initiation. High ECW/TBW was defined as ≥0.400, and low ALSTI as <7.0 kg/m2 for males and <5.7 kg/m2 for females. Functional independence at discharge was assessed using the modified Rankin Scale (mRS), with scores of 0–2 defined as independent and 3–6 defined as non-independent. Multivariate logistic regression analysis was used to examine the effects of the coexistence of high ECW/TBW and low ALSTI on functional independence.

Results

In total, 560 patients were included in the analysis. The number of patients with high ECW/TBW and low ALSTI was 227 (49.4%). Multivariate logistic regression analysis showed that the coexistence of high ECW/TBW and low ALSTI at baseline was a significant associated with non-independence at discharge (odds ratio (OR) = 3.82, 95% confidence interval (CI) 2.00–7.32, P < 0.001), but low ALSTI alone was not (OR = 1.73, 95% CI 0.92–3.22, P = 0.086).

Conclusions

Baseline coexistence of high ECW/TBW and low ALSTI, highlighting the importance of considering fluid imbalance in addition to muscle mass, was associated with for non-independence at hospital discharge in patients with acute stroke.