A Higher Burden of Abnormal Antioxidant-, Nutritional-, and Inflammation-Related Biomarkers Is Associated with Shoulder-Hand Syndrome, Hand Edema, and Short-Term Upper-Limb Outcomes During Stroke Rehabilitation

Abstract

Post-stroke shoulder-hand syndrome and hand edema can complicate inpatient rehabilitation and may reflect interactions between antioxidant, nutritional, inflammatory, and neuro-musculoskeletal factors. This single-center retrospective cohort study included 453 adults admitted for inpatient rehabilitation within 60 days after a first-ever unilateral ischemic or hemorrhagic stroke between 1 January 2018 and 31 December 2025. The primary exposure was the number of abnormal antioxidant-, nutritional-, and inflammation-related biomarkers, defined as serum zinc <70 µg/dL, albumin <3.5 g/dL, C-reactive protein ≥1.0 mg/dL, and neutrophil-to-lymphocyte ratio ≥3.0. The primary outcome was shoulder-hand syndrome or clinically significant hand edema during inpatient rehabilitation. In multivariable logistic regression with robust standard errors, each 1-unit increase in the number of abnormal biomarkers was associated with higher odds of the primary composite outcome (odds ratio, 1.43; 95% confidence interval, 1.15–1.77; p = 0.001). Directionally consistent associations were observed for shoulder-hand syndrome, clinically significant hand edema, Fugl–Meyer upper-extremity score at discharge, and poor upper-limb function at discharge. In a temporal sensitivity analysis excluding the 28 patients with the primary outcome already documented at PM&R admission (N = 425), biomarker profiling preceded the documented outcome in all 98 subsequent event cases, and the association remained (odds ratio, 1.42; 95% confidence interval, 1.12–1.79; p = 0.004). These findings indicate that a higher burden of abnormal antioxidant-, nutritional-, and inflammation-related biomarkers was associated with a clinical profile characterized by upper-limb complications and less favorable short-term motor function; the burden measure is not validated for prediction.

The authors' abstract, as published at the source. Antioxidants, 2026 · DOI ↗