Impact of Prognostic Nutritional Index and Neutrophil-to-Lymphocyte Ratio on Clinical Outcomes of Acute Ischemic Stroke

Objectives: Acute ischemic stroke (AIS) is a significant cause of death and disability worldwide.Inflammation affects brain damage and prognosis in ischemic stroke, while malnutrition significantly impacts clinical outcomes.The prognostic nutritional index (PNI) and neutrophil-to-lymphocyte ratio (NLR) are used to assess nutritional and inflammatory status, respectively.The aim of our study was to determine the role of PNI and NLR in predicting the prognosis of ischemic stroke.Methods: A total of 215 acute ischemic stroke patients hospitalized in our neurology intensive care unit between September 2020 and November 2021 were retrospectively analyzed.Stroke classifications, vascular risk factors, laboratory parameters, and mortality rates of acute ischemic stroke cases were evaluated.PNI and NLR were calculated, and PNI values were dichotomized into two groups using a cutoff point of 42.5, determined via receiver operating characteristic (ROC) analysis.Results: Over a 60-day period, a multivariable logistic regression analysis for neurological prognosis revealed that coronary artery disease (hazard ratio [HR]:3.9,p=0.021), initial National Institutes of Health Stroke Scale (NIHSS) score (HR:1.16,p<0.001), and PNI (HR:0.022,p<0.001) were significant independent predictors of neurological outcomes.Additionally, Cox regression analysis for overall patient survival indicated that age (HR:1.93,p=0.009), initial NIHSS score (HR:1.04,p=0.008), blood urea nitrogen (BUN) level (HR:1.69,p=0.012), and PNI (HR:0.27,p=0.007) were independent factors influencing mortality. Conclusion:PNI and NLR are accessible and cost-effective biomarkers.These indicators provide insights into patients' inflammatory and nutritional profiles, enabling clinicians to make informed treatment decisions and serving as predictors of prognosis in AIS patients.