{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T01:30:09Z","timestamp":1783128609148,"version":"3.54.6"},"reference-count":43,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,12]],"date-time":"2025-07-12T00:00:00Z","timestamp":1752278400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Science and Education of the Russian Federation","award":["075-15-2024-483"],"award-info":[{"award-number":["075-15-2024-483"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Brain injuries, including stroke and traumatic brain injury (TBI), pose a major healthcare challenge due to their severe consequences and complex recovery. While ischemic strokes are more common, hemorrhagic strokes have a worse prognosis. TBI often affects young adults and leads to long-term disability. A critical concern in these patients is the frequent development of chronic critical illness, compounded by metabolic disturbances and malnutrition that hinder recovery. Objective: This study aimed to compare changes in nutritional status parameters under standard enteral nutrition protocols and clinical outcomes in prolonged\/chronic critically ill patients with TBI or stroke versus such a population of patients without TBI or stroke. Methods: This matched prospective\u2013retrospective cohort study included intensive care unit (ICU) patients with TBI or stroke from the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology and patients without these conditions from the eICU-CRD database. Inclusion criteria comprised age 18\u201374 years, ICU stay &gt;5 days, and enteral nutrition. Patients with re-hospitalization, diabetes, acute organ failure, or incomplete data were excluded. Laboratory values and clinical outcomes were compared between the two groups. Propensity score matching (PSM) was used to balance baseline characteristics (age, sex, and body mass index). Results: After PSM, 29 patients with TBI or stroke and 121 without were included. Univariate analysis showed significant differences in 21 laboratory parameters and three hospitalization outcomes. On day 1, the TBI\/stroke group had higher hemoglobin, hematocrit, lymphocytes, total protein, and albumin, but lower blood urea nitrogen (BUN), creatinine, and glucose. By day 20, they had statistically significantly lower calcium, BUN, creatinine, and glucose. This group also showed less change in lymphocytes, calcium, and direct bilirubin. Hospitalization outcomes showed longer mechanical ventilation duration (p = 0.030) and fewer cases of acute kidney injury (p = 0.0220) in the TBI\/stroke group. Conclusions: TBI and stroke patients exhibit unique metabolic patterns during prolonged\/chronic critical illness, differing significantly from other ICU populations in protein\/glucose metabolism and complication rates. These findings underscore the necessity for specialized nutritional strategies in neurocritical care and warrant further investigation into targeted metabolic interventions.<\/jats:p>","DOI":"10.3390\/nu17142302","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T07:54:23Z","timestamp":1752479663000},"page":"2302","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The Neurological Metabolic Phenotype in Prolonged\/Chronic Critical Illness: Propensity Score Matched Analysis of Nutrition and Outcomes"],"prefix":"10.3390","volume":"17","author":[{"given":"Levan B.","family":"Berikashvili","sequence":"first","affiliation":[{"name":"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow 107031, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander E.","family":"Shestopalov","sequence":"additional","affiliation":[{"name":"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow 107031, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6185-349X","authenticated-orcid":false,"given":"Petr A.","family":"Polyakov","sequence":"additional","affiliation":[{"name":"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow 107031, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9903-7257","authenticated-orcid":false,"given":"Alexandra V.","family":"Yakovleva","sequence":"additional","affiliation":[{"name":"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow 107031, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikhail Ya.","family":"Yadgarov","sequence":"additional","affiliation":[{"name":"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow 107031, Russia"},{"name":"V. M. Gorbatov Federal Research Center for Food Systems, Russian Academy of Sciences, Moscow 109316, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7776-9537","authenticated-orcid":false,"given":"Ivan V.","family":"Kuznetsov","sequence":"additional","affiliation":[{"name":"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow 107031, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Tarek S. M.","family":"Said","sequence":"additional","affiliation":[{"name":"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow 107031, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9470-7896","authenticated-orcid":false,"given":"Ivan V.","family":"Sergeev","sequence":"additional","affiliation":[{"name":"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow 107031, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrey B.","family":"Lisitsyn","sequence":"additional","affiliation":[{"name":"V. M. Gorbatov Federal Research Center for Food Systems, Russian Academy of Sciences, Moscow 109316, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexey A.","family":"Yakovlev","sequence":"additional","affiliation":[{"name":"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow 107031, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5442-6950","authenticated-orcid":false,"given":"Valery V.","family":"Likhvantsev","sequence":"additional","affiliation":[{"name":"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow 107031, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1503\/cmaj.140355","article-title":"Diagnosis and Management of Acute Ischemic Stroke: Speed Is Critical","volume":"187","author":"Musuka","year":"2015","journal-title":"Cmaj"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Parr, E., Ferdinand, P., and Roffe, C. (2017). Management of Acute Stroke in the Older Person. Geriatrics, 2.","DOI":"10.3390\/geriatrics2030027"},{"key":"ref_3","first-page":"4","article-title":"\u0421\u0432\u044f\u0437\u044c \u0418\u043c\u043c\u0443\u043do\u043bo\u0433\u0438\u0447\u0435\u0441\u043a\u0438\u0445 \u041fo\u043a\u0430\u0437\u0430\u0442\u0435\u043b\u0435\u0439 \u0441 \u0412o\u0441\u0441\u0442\u0430\u043do\u0432\u043b\u0435\u043d\u0438\u0435\u043c \u0414\u0432\u0438\u0433\u0430\u0442\u0435\u043b\u044c\u043do\u0439 \u0438 \u041ao\u0433\u043d\u0438\u0442\u0438\u0432\u043do\u0439 \u0424\u0443\u043d\u043a\u0446\u0438\u0439 \u041f\u0430\u0446\u0438\u0435\u043d\u0442\u0430 \u0432 \u041e\u0441\u0442\u0440o\u043c \u041f\u0435\u0440\u0438o\u0434\u0435 \u0418\u0448\u0435\u043c\u0438\u0447\u0435\u0441\u043ao\u0433o \u0418\u043d\u0441\u0443\u043b\u044c\u0442\u0430","volume":"20","author":"Tynterova","year":"2024","journal-title":"\u041e\u0431\u0449\u0430\u044f \u0420\u0435\u0430\u043d\u0438\u043c\u0430\u0442o\u043bo\u0433\u0438\u044f"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Takahata, H., Tsutsumi, K., Baba, H., Nagata, I., and Yonekura, M. (2011). Early Intervention to Promote Oral Feeding in Patients with Intracerebral Hemorrhage: A Retrospective Cohort Study. BMC Neurol., 11.","DOI":"10.1186\/1471-2377-11-6"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s13539-011-0024-8","article-title":"Sarcopenia in Stroke-Facts and Numbers on Muscle Loss Accounting for Disability after Stroke","volume":"2","author":"Scherbakov","year":"2011","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1177\/0884533611405793","article-title":"Nutrition for Brain Recovery after Ischemic Stroke: An Added Value to Rehabilitation","volume":"26","author":"Aquilani","year":"2011","journal-title":"Nutr. Clin. Pract."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1016\/S0140-6736(12)60864-2","article-title":"Early Management of Severe Traumatic Brain Injury","volume":"380","author":"Rosenfeld","year":"2012","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Likhvantsev, V.V., Berikashvili, L.B., Yadgarov, M.Y., Yakovlev, A.A., and Kuzovlev, A.N. (2024). The Tri-Steps Model of Critical Conditions in Intensive Care: Introducing a New Paradigm for Chronic Critical Illness. J. Clin. Med., 13.","DOI":"10.3390\/jcm13133683"},{"key":"ref_9","first-page":"339","article-title":"The Chronically Critically Ill: To Save or Let Die?","volume":"30","author":"Girard","year":"1985","journal-title":"Respir. Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1097\/CCM.0000000000000710","article-title":"The Epidemiology of Chronic Critical Illness in the United States","volume":"43","author":"Kahn","year":"2015","journal-title":"Crit. Care Med."},{"key":"ref_11","first-page":"1827","article-title":"Clinical Review 95: Acute and Prolonged Critical Illness as Different Neuroendocrine Paradigms","volume":"83","author":"Bouillon","year":"1998","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_12","first-page":"3062","article-title":"Leptin Levels in Protracted Critical Illness: Effects of Growth Hormone-Secretagogues and Thyrotropin-Releasing Hormone","volume":"83","author":"Wouters","year":"1998","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"848","DOI":"10.4187\/respcare.01736","article-title":"Definitions and Epidemiology of the Chronically Critically Ill","volume":"57","author":"Carson","year":"2012","journal-title":"Respir. Care"},{"key":"ref_14","first-page":"480","article-title":"Strategies to Combat Chronic Critical Illness","volume":"19","author":"Maguire","year":"2013","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Fenner, B.P., Darden, D.B., Kelly, L.S., Rincon, J., Brakenridge, S.C., Larson, S.D., Moore, F.A., Efron, P.A., and Moldawer, L.L. (2021). Immunological Endotyping of Chronic Critical Illness After Severe Sepsis. Front. Med., 7.","DOI":"10.3389\/fmed.2020.616694"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1016\/j.amjsurg.2020.07.016","article-title":"Abdominal Sepsis Patients Have a High Incidence of Chronic Critical Illness with Dismal Long-Term Outcomes","volume":"220","author":"Cox","year":"2020","journal-title":"Am. J. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1097\/CCM.0000000000004723","article-title":"Epidemiology of Chronic Critical Illness in Japan: A Nationwide Inpatient Database Study","volume":"49","author":"Ohbe","year":"2021","journal-title":"Crit. Care Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1089\/neu.2011.1801","article-title":"Early Enteral Nutrition and Clinical Outcomes of Severe Traumatic Brain Injury Patients in Acute Stage: A Multi-Center Cohort Study","volume":"29","author":"Chiang","year":"2012","journal-title":"J. Neurotrauma"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2535","DOI":"10.1016\/j.clnu.2021.04.018","article-title":"Association between Malnutrition and Long-Term Mortality in Older Adults with Ischemic Stroke","volume":"40","author":"Yuan","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"104859","DOI":"10.1016\/j.ijnurstu.2024.104859","article-title":"Nutritional Assessment in Acute Stroke Patients: A Systematic Review of Guidelines and Systematic Reviews","volume":"158","author":"Mancin","year":"2024","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"177","DOI":"10.13004\/kjnt.2023.19.e31","article-title":"Nutrition Therapy for Patients With Traumatic Brain Injury: A Narrative Review","volume":"19","author":"Jeong","year":"2023","journal-title":"Korean J. Neurotrauma"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1001\/archneurol.2007.12","article-title":"Undernutrition as a Predictor of Poor Clinical Outcomes in Acute Ischemic Stroke Patients","volume":"65","author":"Yoo","year":"2008","journal-title":"Arch. Neurol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e3","DOI":"10.12786\/bn.2022.15.e3","article-title":"Nutritional Supplementation in Stroke Rehabilitation: A Narrative Review","volume":"15","author":"Ko","year":"2022","journal-title":"Brain Neurorehabil."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Poblete, R.A., Yaceczko, S., Aliakbar, R., Saini, P., Hazany, S., Breit, H., Louie, S.G., Lyden, P.D., and Partikian, A. (2023). Optimization of Nutrition after Brain Injury: Mechanistic and Therapeutic Considerations. Biomedicines, 11.","DOI":"10.3390\/biomedicines11092551"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"180178","DOI":"10.1038\/sdata.2018.178","article-title":"The EICU Collaborative Research Database, a Freely Available Multi-Center Database for Critical Care Research","volume":"5","author":"Pollard","year":"2018","journal-title":"Sci. Data"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"(2013). World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. Jama, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e7586","DOI":"10.1136\/bmj.e7586","article-title":"SPIRIT 2013 Explanation and Elaboration: Guidance for Protocols of Clinical Trials","volume":"346","author":"Chan","year":"2013","journal-title":"BMJ"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1016\/j.ijsu.2014.07.014","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"12","author":"Altman","year":"2014","journal-title":"Int. J. Surg."},{"key":"ref_29","first-page":"38","article-title":"CONUT: A Tool for Controlling Nutritional Status. First Validation in a Hospital Population","volume":"20","author":"Mancha","year":"2005","journal-title":"Nutr. Hosp."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1002\/pst.433","article-title":"Optimal Caliper Widths for Propensity-Score Matching When Estimating Differences in Means and Differences in Proportions in Observational Studies","volume":"10","author":"Austin","year":"2011","journal-title":"Pharm. Stat."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e4","DOI":"10.12786\/bn.2022.15.e4","article-title":"Nutrition Management in Patients With Traumatic Brain Injury: A Narrative Review","volume":"15","author":"Lee","year":"2022","journal-title":"Brain Neurorehabil."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1093\/nutrit\/nuac034","article-title":"The Relationship between Nutritional Status at the Time of Stroke on Adverse Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies","volume":"80","author":"Mehta","year":"2022","journal-title":"Nutr. Rev."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Thuemmler, R.J., Pana, T.A., Carter, B., Mahmood, R., Silva, J.H.B., Metcalf, A.K., Mamas, M.A., Potter, J.F., and Myint, P.K. (2024). Serum Albumin and Post-Stroke Outcomes: Analysis of UK Regional Registry Data, Systematic Review, and Meta-Analysis. Nutrients, 16.","DOI":"10.3390\/nu16101486"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Brooks, G.A., and Martin, N.A. (2015). Cerebral Metabolism Following Traumatic Brain Injury: New Discoveries with Implications for Treatment. Front. Neurosci., 9.","DOI":"10.3389\/fnins.2014.00408"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Gribnau, A., van Zuylen, M.L., Coles, J.P., Plummer, M.P., Hermanns, H., and Hermanides, J. (2024). Cerebral Glucose Metabolism Following TBI: Changes in Plasma Glucose, Glucose Transport and Alternative Pathways of Glycolysis\u2014A Translational Narrative Review. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25052513"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"241","DOI":"10.3171\/jns.1997.86.2.0241","article-title":"Cerebral Hyperglycolysis Following Severe Traumatic Brain Injury in Humans: A Positron Emission Tomography Study","volume":"86","author":"Bergsneider","year":"1997","journal-title":"J. Neurosurg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1186\/s12933-024-02231-0","article-title":"Long-Term Survival in Stroke Patients: Insights into Triglyceride-Glucose Body Mass Index from ICU Data","volume":"23","author":"Huang","year":"2024","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Wang, Y., Jiang, G., Zhang, J., Wang, J., You, W., and Zhu, J. (2023). Blood Glucose Level Affects Prognosis of Patients Who Received Intravenous Thrombolysis after Acute Ischemic Stroke? A Meta-Analysis. Front. Endocrinol, 14.","DOI":"10.3389\/fendo.2023.1120779"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"E10","DOI":"10.3171\/2021.11.FOCUS21586","article-title":"Central Nervous System Injury-Induced Immune Suppression","volume":"52","author":"Sribnick","year":"2022","journal-title":"Neurosurg. Focus"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Hazeldine, J., Lord, J.M., and Belli, A. (2015). Traumatic Brain Injury and Peripheral Immune Suppression: Primer and Prospectus. Front. Neurol., 5.","DOI":"10.3389\/fneur.2015.00235"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"4269","DOI":"10.1111\/ejn.16174","article-title":"Post-Stroke Immunosuppression: Exploring Potential Implications beyond Infections","volume":"58","author":"Brea","year":"2023","journal-title":"Eur. J. Neurosci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"101","DOI":"10.5607\/en20033","article-title":"Immunosuppression and Neuroinflammation in Stroke Pathobiology","volume":"30","author":"Jiang","year":"2021","journal-title":"Exp. Neurobiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2638","DOI":"10.4103\/1673-5374.373678","article-title":"Molecular Chaperones in Stroke-Induced Immunosuppression","volume":"18","author":"Qiao","year":"2023","journal-title":"Neural Regen. Res."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/14\/2302\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:09:00Z","timestamp":1760033340000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/14\/2302"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,12]]},"references-count":43,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["nu17142302"],"URL":"https:\/\/doi.org\/10.3390\/nu17142302","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,12]]}}}