The prognostic role of prognostic nutritional score, geriatric nutritional risk index, and controlling nutritional status score in critically ischemic geriatric patients with acute ischemic stroke: A retrospective cohort study

Acute ischemic stroke (AIS) is a major cause of functional disability and mortality in the geriatric population. This study aimed to evaluate the predictive performance of the prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), and the controlling nutritional status (CONUT) score for in-hospital mortality among critically ill geriatric patients. Critically ill AIS patients admitted to a tertiary hospital intensive care unit from January 2021 to January 2023 were retrospectively analyzed. Patients were classified into survivor and mortality groups. Nutritional scores were calculated: PNI = (10 × serum albumin [g/dL]) + (0.005 × total lymphocyte count); GNRI = (1.489 × albumin [g/dL]) + (41.7 × [body weight/ideal body weight]); CONUT (scored 0-12 based on serum lymphocyte count, cholesterol, and albumin). The predictive performances of the scores for in-hospital mortality were compared. A total of 142 patients were included, with 25 in the mortality group and 117 in the survivor group. The median age was 77 (range: 68-84) years, and 55.6% (n = 79) were female. Demographic characteristics (age, sex, body mass index) were similar between groups. Median PNI (36.3 vs 39.5, P = .017), GNRI (53.4 vs 56.6, P = .007), and CONUT (2 vs 2, P = .012) scores were significantly lower in the mortality group. Multivariate regression analysis showed that GNRI was an independent predictor of mortality (odds ratio = 0.935, 95% confidence interval = 0.877-0.998, P = .042). Receiver operating characteristic analyses showed a PNI cutoff value of ≤34.2 (area under curve [AUC] 0.653, 0.535-0.770), GNRI ≤56.2 (AUC 0.672, 0.577-0.767), and CONUT ≥1.5 (AUC 0.659, 0.545-0.773). Nutritional scores such as PNI, GNRI, and CONUT can predict mortality in critically ill geriatric AIS patients in the intensive care unit. Their prognostic performances were found to be similar.